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LINOIS  HISTORICAL  SURVEY 


1 

•~  .'   ;   '   C' 


HISTORY 


MEDICAL  EDUCATION 

AND  INSTITUTIONS 


FROM  THE  FIRST  SETTLEMENT  OF  THE  BRITISH 
COLONIES  TO  THE  YEAR  1850; 


WITH    A    CHAPTER    ON    THE 


|tertit  (taMtinu  mift  WwAs  nf  tin? 

AND    THE 

MEANS    NECESSARY    FOR     SUPPLYING   THOSE   WANTS,   AND 

ELEVATING  THE  CHARACTER  AND  EXTENDING  THE  USEFULNESS  OF  THE 

WHOLE  PROFESSION. 


BY  N.  S.  DAVIS,  M.D., 

PROF.  CF  PRINCIPLES  AND  PRACTICE  OF  MEDICINE  IN  RUSH  MEDICAL  COLLEGE! 

MEMBER    OF    THE    AMKR.  MED.   ASSOCIATION  ;    PERMANENT    MEMBER 

OF    THE    MED.    SOCIETY    OF    THE    STATE    OF    NEW    YORK; 

CORRESPONDING    MKMBF.R    OF    THE    N.  Y.    MED. 

ASSOCIATION  J   MEMBER  OF  THE  ILLINOIS 

STATE  MEDICAL  SOCIETY  j 

ETC. 


CHICAGO: 

S.  C.  GRIGGS  &  CO.,  PUBLISHERS,  111  LAKE-STREET 

W.  J.  PATTKK.30N.  PRINTER.  73  LAKE-STREET. 

AI  J)  OO<I  l.l. 

i      :  i 


Entered  according  to  Act  of  Congress,  in  the  year  1850, 

BY  NATHAN  S.  DAVIS. 
In  the  Clerk's  Office  of  the  District  Court  of  the  State  of  Illinois. 


?v 


r-  TO 

MY  ESTEEMED  FRIEND  AND  BENEFACTOR, 

DR.   WILLARD  PARKER,  OF  NEW  YORK, 

ESPECIALLY   J    AND  TO  THE 

MEDICAL    PROFESSION    OF    THE    UNITED    STATES 

GENERALLY, 

THIS  WORK  IS  MOST  RESPECTFULLY  INSCRIBED  BY 

THE  AUTHOR. 


; 


• 

0 

r 
•-• 
\  - 


253026 


THE  prominent  position  which  the  sub- 
ject of  Medical  Education  now  occupies 
in  the  minds  of  all  enlightened  members  of 
the  profession,  makes  a  review  of  the  past 
not  only  peculiarly  appropriate,  but  also, 
in  the  highest  degree,  profitable.  Indeed, 
without  such  review,  and  a  careful  tracing 
of  present  evils  and  defects  to  their  origin 
and  remote  causes,  no  member  of  the  pro- 
fession can  be  prepared  to  act  wisely  his 
part  in  the  great  progressive  movements  of 
'the  age ;  or  can  discharge,  with  fidelity, 
the  duties  devolving  on  him,  as  a  member 
of  a  learned  and  honorable  profession. 
Wherever  changes  are  made,  or  improve- 
ments attempted,  in  matters  affecting,  more 
or  less  directly,  the  interests  of  large 
classes  of  men,  it  is  to  be  expected  that 
much  diversity  of  opinion  will  prevail  con- 
cerning the  propriety  and  ultimate  effects 


VI.  PREFACE, 

of  such  changes  or  improvements.  But  it 
is  not  unfrequently  the  case,  that  far  the 
greater  share  of  such  diversity  arises  either 
from  ignorance  of  the  real  nature  of  the 
evils  to  be  remedied,  or  a  misapprehension 
of  the  proposed  remedies.  Hence,  if  we 
would  aid  in  the  correction  of  ahuses  our- 
selves, or  even  avoid  standing  as  stumbling- 
blocks  in  the  way  of  the  action  of  others, 
we  must  search  carefully  the  progress  of 
medical  education  from  the  commencement 
of  our  existence  as  .a  nation,  and  thereby 
trace  effects  to  their  real  causes  ;  for  it  is 
not  every  coincident  that  bears  the  rela- 
tion of  cause  and  effect ;  or  every  appa- 
rently remote  object  or  consequence  that 
we  are  to  consider  as,  prima  facie,  inde- 
pendent of  what  has  preceded.  And  there 
is  probably  no  more  difficult  mental  task 
than  that  of  tracing  accurately  the  chain  of 
causation  in  the  progress  of  any  class  of 
human  society.  Yet  on  this  depends  the 
whole  value  of  history.  Without  it,  in- 
stead of  being  "philosophy  teaching  by 
example,"  it  becomes  a  mere  record  of 


PREFACE.  Vli. 

isolated  facts,  quite  as  susceptible  of  a 
wrong  as  a  right  application.  It  is  from 
this  cause  that  much  of  what  bears  the 
name  of  history,  both  civil  and  military, 
has  been  of  so  little  practical  benefit  to 
mankind. 

Keeping  this  important  truth  constantly 
in  mind,  I  have  endeavored,  in  the  follow- 
ing pages,  not  only  to  embody  all  the  facts 
in  regard  to  the  educational  history  of  the 
medical  profession  in  this  country,  but  also 
to  develop  the  origin  or  causes  of  each, 
and  the  object  it  was  designed  to  accom- 
plish. 

If  I  have  been  successful  in  this,  I  am 
conscious  that  the  work  will  be  found  of 
great  value  to  the  profession,  and,  through 
it,  to  mankind.  For  man  is  so  constituted 
that  he  can  judge  rationally  of  the  future 
only  by  the  experience  of  the  past ;  and 
that  man,  or  that  class  of  men,  will  possess 
the  highest  degree  of  practical  wisdom, 
who  treasure  up  this  experience  with  most 
care  and  correctness.  Why  is  it  that  one 
generation  alter  another,  not  of  individuals 


Vlll.  PREFACE. 

only,  but  of  whole  communities  and  na- 
tions, are  found  pursuing  the  same  general 
course,  committing  the  same  errors,  suffer- 
ing the  same  evils,  and  finally  perishing  from 
essentially  the  same  causes  ?  Simply  be- 
cause they  learn  nothing  from  the  history 
of  those  who  have  preceded  them.  Hence 
the  youth  who,  when  admonished  by  his 
father  to  shun  certain  vices,  because  he 
had  experienced  their  folly,  replied  that  he 
wished  to  "  know  their  folly  by  experience^ 
too,"  is  a  fit  representative  of  communities 
and  nations.  And  it  ever  will  be  so,  until 
history  itself  advances  from  a  mere  record 
of  facts,  concerning  the  movements  of  con- 
tending armies  and  the  intrigues  of  courts, 
to  the  character  of  a  true  exponent  of  hu- 
man motives,  means,  and  ends,  both  indi- 
vidually and  collectively.  When  history 
attains  this  character,  and  becomes  uni- 
versally studied,  then  will  man  profit  by  the 
experience  of  his  fathers,  and  each  gene- 
ration become  wiser  than  its  predecessor. 

In  the  following  pages,  I  have  divided  the 
educational    history   of  the    medical    pro- 


PREFACE.  IX. 

fession  into  three  periods.  The  first,  or 
colonial  period,  extends  from  the  first  set- 
tlement of  the  colonies  to  the  termination 
of  the  Revolutionary  War ;  the  second  ex- 
tends from  this  period  to  the  year  1806, 
when  the  profession  in  the  state  of  New 
York  was  organized  into  societies,  by  legal 
enactment ;  and  the  third  extends  from  the 
termination  of  the  second  to  the  present 
time.  To  these  I  have  added  a  fourth  chap- 
ter, stating  more  fully  what  I  consider 
errors  and  defects  in  the  present  system, 
and  my  views  concerning  the  appropriate 
remedies. 

For  a  large  portion  of  the  facts  pre- 
sented, I  am  indebted  to  the  various  medi- 
cal periodicals  of  our  country,  and  especially 
to  the  writings  of  Brs.  J.  B.  Beck,  T. 
Romayne  Beck,  S,  W.  Williams,  John 
Stearns,  Benjamin  Rush,  Nicholas  Ro- 
mayne, William  Douglass,  John  Morgan, 
Peter  Middleton,  and  others, 

I .  am  conscious  that  much  has  been 
omitted  which  it  would  have  been  proper 
to  insert,  especially  in  regard  to  medical 


X.  PREFACE. 

eocieties  in  i^any  of  our  cities ;  but  as  most 
of  these  were  strictly  local  in  their  charac- 
ter, I  have  used  less  exertion  to  obtain 
historical  facts  in  relation  to  them.  I  am 
also  conscious  that  many  of  the  views  pre- 
sented, particularly  in  the  last  chapter,  will 
meet  with  severe  animadversions  from  a 
portion  of  the  medical  press  ;  but,  as  they 
are  the  result  of  an  extensive  examination 
of  facts  and  mature  reflection,  I  give  them 
to  my  professional  brethren,  asking  no 
other  favor  than  that  they  be  attentively 
read,  fairly  and  truthfully  quoted  or  repre- 
sented, and  criticised  with  that  spirit  of 
frankness  and  candor  which  is  due  to  all 
subjects  of  importance. 

N.  S.  DAVIS. 

CHICAGO,  ILL.,  November,  1850. 


CONTENTS. 


CHAPTER  I. 

fiO«. 

History  of  the  Medical  Profession  and  Medical  Education 
in  the  British  Colonies  of  America,  from  their  first 
settlement  to  the  achievement  of  their  Independence,  18 

CHAPTER  IL 

History  of  Medical  Education  and  Institutions  in  the 
United  States  of  America,  from  the  year  one  thousand 
seven  hundred  and  eighty-three  to  one  thousand  eight 
hundred  and  six, 40 

CHAPTER   IIL 

The  same  continued  from  the  year  one  thousand  eight 
hundred  and  six  to  the  present  time  (one  thousand 
eight  hundred  and  fifty,) 83 

CHAPTER  IV. 

On  the  Present  Condition  and  Wants  of  the  Medical  Pro- 
fession in  the  United  States,  and  the  Remedies  for 
those  wants,  .  .  .  .  .  .  .  .162 


pr          % 


HISTORY 


MEDICAL  EDUCATION, 

ETC. 


CHAPTER  I. 

FROM  THE  FIRST  SETTLEMENT  OF  THE  COLONIES 
TO  THE  YEAR  1783. 

THE  origin  of  the  institutions  of  this,  unlike 
those  of  most  other  countries,  is  involved  in  no 
obscurity ;  and  is  to  be  traced  to  no  remote  chi- 
valric  or  feudal  age.  On  the  contrary,  they  have 
all  had  their  birth  since  the  middle  of  the  seven- 
teenth century ;  and  been  exposed  to  the  full  gaze 
.of  an  enlightened  world. 

This,  together  with  the  fact,  that  they  have 
not  only  had  their  beginning,  but  their  maturity 
thus  far,  among  the  most  enterprising  people,  and 
under  the  influence  of  the  most  liberal  govern- 
ment on  earth,  renders  every  thing  connected 
with  their  history  doubly  interesting  and  import- 
ant, as  affording  the  fairest  illustrations  of  human 


14  MKDICAL    HISTORY. 

anil,  consequently,  the    most    valuable 
-is  of  human  experience. 

J  '1  lie  medical  profession  in  the  United  States, 
and.  indeed,  througliout  the  civilized  world,  con- 
stitutes an  important  part  of  society  ;  for  while,  on 
the  one  hand,  its  ranks  can  boast,  not  only  of 
names  of  the  highest  eminence  in  every  depart- 
me'nt  of  science  and  literature,  but  can  also  claim 
to  be  equal  with  the  foremost  in  every  enterprise 
for  extending  human  knowledge,  and  ameliorating 
human  suffering,  its  free  access  to  the  homes  arid 
firesides  of  all  classes,  gives  it  a  moral  and  social 
influence  of  the  most  potent  character.  And  in 
110  part  of  the  world  is  this  influence  more  exten- 
sive) \  or  happily  felt,  than  in  this  country  ,Ijyhere 
the  absence  of  all  hereditary  distinctions  and 
privileged  orders,  leaves  learning  arid  virtue  free 
to  assume  their  own  native  eminence j 

Jrls  far  ii>  can  now  be  ascertained,  but  very  few 
regularly  educated  physicians  embarked  with  the 
lirsi  colonists  that  planted  themselves  in  the  wild- 
enu  >s  of  Amferic&J  \Ve  are  told  by  Dr.  !S.  W. 
Williams,  of  Deerfield.  lhat  Dr.  Samuel  Fuller,  a 
:  .  '..u'iy  educated  physician  and  highly  esteemed 
man.  accompanied  the  first  emigrants  who  landed 
at  Plymouth  in  16:£0.  He  was  a  faithful  and  de- 
practitioner,  and  died  of  an  infectious  fever 
at  Plymouth,  in  163Q.  Tii-  me  of  Dr.  llusteii  is 


Ml'.DUAL    IlL-TOUY.  15 

1  S 

also  mentioned  as  a  companion  of  Captain  Smith, 
in  his  survey  of  Chesapeake  Bay  in  ;iu  op.-n 
in  1608.  But  the  fact  that  Smith  was  obliged  to 
return  to  Europe  the  very  next  year,  to  procure 
surgical  aid,  on  account  of  an  injury  to  his  hand, 
"  there  being  none  to  be  had  in  the  colony,"  shows 
that  Dr.  Russell's  stay  was  short,  or  else  he  was 
not  a  man  skilled  in  his  profession.  These  are 
the  only  names  that  we  can  find  mentioned 
among  the  first  settlers,  either  at  Jamestown,  Ply- 
mouth, or  New  York.  The  fact  that  there  were 
either  kery  few  physicians  among  the  early  colo- 
nists^ or  that  they  were  pooriy  prepared  to  dis- 
charge their  responsible  duties,  is  further  corrobo- 
rated by  the  almost  total  neglect  of  those  sanitary 
regulations  so  necessary  to  preserve  their  health, 
and  the  consequent  great  mortality  that  took  place 
in  all  the  colonies  during  the  first  few  years.  A 
surgeon  is  mentioned  as  on  board  one  of  the  ships 
sent  to  aid  Capt.  Mason  in  his  expedition  against 
the  Pequoit  Indians  in  1637,  but  whether  he  be- 
longed to  the  colony,  or  the  ship  merely,  is  not 
known.  In  1649,  we  find  a  law  passed  by  the 
Massachusetts  Colony,  forbidding  "Chirurgeons, 
Midwives,  Physicians,  or  others,  to  exercise,  or 
put  forth  any  act  contrary  to  the  known  rules  of 
art,  in  each  mystery  and  occupation,  to  exercise 
any  force,  or  violence,  or  cruelty,  upon  or  toward 


f 


16  MEDICAL    HISTORY. 

the  body  of  any,  whether  young  or  old  (  not  even 
in  the  most  desperate  cases)  without  the  advice 
and  consent  of  such  as  are  skillful  in  the  same  art, 
(if  any  such  may  be  had,)  or  at  least,  of  the 
wisest  and  gravest  there  present,  and  consent  of 
the  patient  or  patients,  if  they  be  mentis  compotes, 
much  less  contrary  to  such  advice  and  consent, 
etc."  This  provision  is  sufficiently  indicative  of 
the  condition  of  the  profession,  at  this  early  pe- 
riod, in  the  New  England  States. 

Indeed,  with  the  exception  of  the  two  Govern- 
ors  Winthrop,   one   of    Massachusetts   and   the 
other  of  Connecticut,  and  a  few  of  the  clergy,  we 
find  no  nahies  of  even  respectable  attainments  in 
the  profession,  during  the  first  half  century  after 
the  commencement  of  our  colonial  existence. — 
/The  younger  Winthrop  not  only  practised  medi- 
|  cine  extensively,  but  was  also  a  member  of  the 
\  Royal  Society  of  London,  to  which  he  made  seve- 
\ral    respectable    communications.     And  even  s<> 
late  as  1753,  we  are  told  by  the  Independent  Re- 
flector, a  paper  then  published  in  the  city  of  New 
York,   "  that  it  (the  city  of  N.Y.,  then  containing 
about    10,000  inhabitants)   could  boast  of  more 
than  forty  gentlemen  of  the  faculty,  the  greatest 
part  of  whom  were  mere  pretenders  to  a  profes- 
sion, of  which  they  were  entirely  ignorant :  and 
convincing    proofs    of     their    incapacity    were 


MEDICAL    HISTORY.  17 

exemplified  in  their  iniquitous  practices.  The 
advertisements  they  published  proved  them  igno- 
rant of  the  very  names  of  their  drugs"  etc.  etc.  Dr. 
Nicholas  Romaine,  in  his  annual  address  before 
the- New  York  State  Medical  Society,  (in  1811) 
speaking  ol  this  early  period,  says  :  "  It  would  be 
painful  to  intrude  on  your  notice,  the  humble. 
condition  of  medicine  which  seems  to  have 
existed  for  more  than  a  century  after  the  first 
settlement  of  this  State. — It  could  only  consist  of  \ 
a  statement  of  the  arts  and  intrigues,  by  which 
the  practitioners  of  physic  succeeded  in  advanc- 
ing their  private  interests  and  professional  enx>-  / 
lum.iiits."  The  reasons  for  such  a  state  of  things/ 
at  this  period,  are  obvious, — there  being  no  medi- 
cal schools  li  the  colonies,  or  any  institutions  for 
the  instruction  of  medical  students/  the  only 
sources  of  supply  consisted  in  emigrations  from 
the  mother  .country,  or  in  the  sending  of  native 
young  men  to  the  hospitals  and  colleges  of  Eu-  I 
rope. 

The  circumstances  of  the  country  during  the 
whole  of  the  first  century  were  such,  that  no  man 
already  established  in  practice  on  the  other  side 
of  the  Atlantic,  would  think  of  leaving  it  for  the 
hardships,  the  poverty,  and  wilds  of  America  ; 
while  the  absence  of  oil  lbo«e  medic;>l  societies 

and  institutions,  which  constitute  so  powcfful  an 
I* 


18  MEDICAL    HISTORY. 

object  to  the  aspiring  ambition  of  the  thoroughly 

educated    student,    equally  prevented    this    class 

& "  ~\ 

from  resorting  hither.    (Hence,  as  a  general  ruleA 

only  those  physicians  who  had  failed  to  obtain  a  \ 
practice  at  home,  or  were  too  conscious  of  their     ] 
own  unfitness  to  make  the  attempt,  emigrated  to     I 
America.     On  the  other  hand,  the  great  expense^/ 
attending  the  education  of  young  men  belonging 
to  the  colonies,  in  the  medical  institutions  of  Eu- 
rope, operated  as  an  equal  barrier  to  this  source. 
Thus.it  was,  that  while  persecution  filled  the  cle- 
rical ranks  of  the  colonies  with  men  of  the  deepest 
piety,    and    the    most    varied   learning,   and    the 
patronage  of  the  crown  induced  a  full  supply  of 
legal  talent,(the  profession  of  medicine  sunk  to  a    j 
comparatively  low  stated 

In  New  England,  the  greater  number  of  those\ 
who  practiced  medicine  were  priests,  whose  medi-  \ 
cal    knowledge   was   chiefly   derived   from    the 
writings   of  Hippocrates,   Galen.  Aretaeus,   etc., 
which  they  had  read  during  their  collegiate  edu- 
cation in  Europe.     Some  of    the  nonconformist  y 
clergy,  however,  who  were  persecuted  or  silenced    I 
in  the  Old  World,  went  through  with  a  regular    \ 
course  of  medical   studies   before  leaving  home. 

C 

Zd  afterwards  became  exceedingly  useful,  both    I 
physicians  and  preachers,  among  tho  colonists 
here.     Of  this  number,  were  Drs.  Gi]f<s  Firmer 


MEDICAL    HISTORY.  19 

and  John  Fisk  ;  the  first  arrived  in  New  England 
1633,  and  the  last  in  1637.  Both  lived  to  an 
advanced  age,  and  were  highly  respectedr  Dr. 
Thomas  Thatcher  also  came  about  the  same 
time;  and  his  pamphlet,  entitled  "A  Guide  in 
Small-Pox  and  Measles,"  published  in  1677,  is 
said  to  be  the  jirst  medical  publication  in  America../'' 
''About  the  middle  of  the  seventeenth  century,  Drs. 
Bellinghatn  and  Henry  Saltonstall,  after  receiv- 
ing a  general  education  at  Harvard  College,  went 
to  England,  where  they  completed  a  full  course 
of  medical  studies,  received  the  degree  of  M.D., 
and  returned  to  practice  their  profession  in  the 
Massachusetts  Colony.  These  Avere  the  first 
young  men  of  whom  we  can  get  any  account, 
who  left  the  colonies  to  obtain  a  regular^nejicai 
education  in  the  mother  country,  for  the  purpose 
of  practicing  here.  / 

/But  during  the  latter  part  of  the  first  half  of 
tire  eighteenth  century,  a  new  era  began  to  dawn 
on  the  medical  profession  in  America.  It  was 
during  this  period  that  we  find  several  young  men 
of  the  highest  order  of  native  talent,  after  receiv- 
ing a  thorough  course  of  instruction  in  the  medi- 
c;il  institutions  of  Great  Britain  and^he  Conti- 
nent, returning  to  practice  their  profession  in 
the  New  World.  )  Among  these  we  find  the 
of  Dr.  ZabdieJ  Bovlston  and  Dr.  James 


20  MEDICAL    HISTOBY. 

Lloyd,  of  r.Iassaehusetts ;  Lieut.  Gov.  Golden 
and  Dr.  James  Ogden,  oi'  New  York  ;  Drs.  John 
Morgan,  William  Shippen,  Jr.,  and  Benjamin 
Rush,  of  Pennsylvania  ;  Drs.  John  Mitchell  arid 
Thomas  of  Virginia;  and  Dr.  Lining  of  South 
Carolina — names,  that  will  ever  remain  as  orna- 
ments to  the  medical  profession  in  America. 

During  this  period,  other  circumstances  also 
occurred  which  aided  very  much  the  advance- 
ment of  the  profession. — Wars  between  England 
and  France,  were  carried  on,  with  only  short 
intervals  of  peace,  during  the  greater  part  of  the 
eighteenth  century.  And  so  early  as  1690,  hos- 
tilities commenced  between  New  York  and  New 
England,  on  the  side  of  England,  and  the  French 
settlements  in  New  Brunswick  and  Canada. 
From  this  time  to  the  final  subjugation  of  the 
French  colonies  in  1763,  many  expeditions  were 
sent  from  England  to  aid  the  colonists,  and  each 
was  accompanied  by  a  well  appointed  medical 
:>taff.  These  being  almost  constantly  in  the  colo- 
nies, with  the  military  hospitals  which  necessarlly 
accompanied  the  movements  of  regular  armies, 
.supplied  the  place,  in  some  degree,  of  medical 
schools,  «p]d  doubdess  excited  the  ambition  of 
many  of  the  vomitr  men,  who,  during  the  lr;tt-T 
part  of  this  period,  spent  some  time  in  Europe, 
iii-id'- •  bunders  of  medical 


MEDICAL    HISTORY.  21 

science  in  America.  What  Dr.  Nicholas  Ro- 
maine  says  of  the  influence  of  these,  on  the 
medical  profession  of  New  York,  is  equally  true  of 
New  England,  Pennsylvania,  and  Virginia.  In 
his  annual  address  to  the  Medical  Society  of  the 
State  of  New  York,  in  1811,  to  which  we  have 
already  alluded,  Dr.  Romaine  says  :  "  The  war 
which  effected  the  conquest  of  Canada,  was,  per- 
haps, the  first  circumstance  which  materially 
improved  the  condition  of  medicine  in  this  State 
(New  York).  The  English  army  employed  for 
that  purpose,  left  Europe,  accompanied  by  a  highly 
respectable  medical  staff,  most  of  whom  landed 
in  the  city  of  New  York,  and  continued  some 
years  in  the  neighboring  territories,  affording  to 
many  young  Americans  opportunities  of  attend- 
ing the  military  hospitals,  and  receiving  such 
professional  instruction  as  gave  them  afterward 
consideration  with  the  public.  The  physicians 
and  surgeons  of  the  Anglo-American  army  gained 
the  confidence  of  the  public,  by  their  superior 
deportment  and  professional  information.  The 
military  establishments  in  this  State,  after  the 
Canadian  war,  required  medical  and  surgical 
attendants,  so  that  the  people  had  the.benefit  of 
their  advice.  In  this  manner  a  new  order  of 
medical  men  was  introduced  into  the  commu- 
nity.' 


22  MEDICAT,    HISTORY. 

It  was  doubtless  owing  to  the  increased  atten- 
tion to  medical  science  and  practice,  produced  by 
these  causes,  that  led  the  colony  of  New  York  to 
make  the  first  effectual  attempt  to  regulate  the 
education  and  practice  of  the  profession  by  legal 
enactment.  We  have  already  quoted  from  the 
Independent  Reflector  of  1753,  a  paper  which  not 
only  exposed  the  ignorance  and  pretensions  of  the 
profession,  but  appealed  wHh  boldness  and  energy 
to  the  people  for  a  remedy ;  and  some  of  the 
arguments  presented,  would  afford  useful  lessons 
for  many  legislators  of  tbe  present  day. 

It  was  not  until  1760  .that  the  General  Assem- 
bly of  New  York  ordained  that,  "no  person 
whatsoever  should  practice  as  physician  or  sur- 
geon, in  the  city  of  New  York,  before  he  shall 
have  been  examined  in  physic  and  surgery,  and 
approved  of  and  admitted  by  one  of  His  Majesty's 
Council,  the  Judges  of  the  Supreme  Court,  the 
King's  Attorney  General,  and  the  Mayor  of  the 
city  of  New  York  for  the  time  being,  or  by  any 
three  or  more  of  them,  taking  to  their  assistance 
for  such  examination,  such  proper  person  or  per- 
sons as  they  in  their  discretion  shall  see  fit." 

Such  candidates  as  were  approved  received 
certificates,  conferring  the  right  to  practice  physic 
or  surgery?  or  both,  throughout  the  whole  pro-' 
viuce  ;  and  a  penalty  of  five  pounds  was  prescribed 


MEDICAL    HISTORY.  23 

for  all  violations  of  this  law.  Its  restrictive 
operation,  however,  was  confined  exclusively  to 
the  city  and  county  of  New  York;  and,  with  the 
exception  of  a  similar  enactment  in  the  colony  of 
New  Jersey,  in  the  year  1772,  it  was  the  only 
attempt  to  regulate  the  qualifications  and  practice 
of  physicians  by  any  of  the  colonial  governments 
previous  to  the  Revolutionary  War. 

But  the  causes  to  which  we  have  alluded,  had 
already  introduced  into  the  profession  many 
young  men.  possessed  not  only  of  sound  learning, 
but  alsp  of  a  laudable  ambition  for  the  honor  and 
advancement  of  their  favorite  calling.  Among 
these  none  were  more  zealous  in  the  cause  of 
medical  education  than  Drs.  John  Morgan,  and 
William  Shippen,  Jr..  of  Philadelphia;  and  Drs. 
Samuel  Bard,  Peter  Middleton,  and  John  Jones, 
of  New  York.  Although  many-private  and  tem- 
porary hospitals  had  been  established  in  the 
several  colonies,  for  the  accommodation  of  seamen, 
and  the  reception  of  patients  for  inoculation,  the 
first  permanent  institution  of  the  kind  was  estab- 
lished in  Philadelphia,  in  1752,  and  was  aided  by 
a  grant  of  £2,000  from  the  Colonial  Assembly. 
Its  establishment  was  owing  to  the  suggestions 
and  exertions  of  Dr.  Thomas  Bond,  who  became  its 
superintendent,  and  we  believe,  the  first  regular 
Clinical  Lecturer  on  Medicine  in  America.  In 


24  MEDICAL    HISTORY. 

1762,  Dr.  William  Shippen  returned  from  his  studies 
_in  Europe, to  settle  in  his  native  city,  Philadelphia; 
and  the  same  year  commenced  a  course  of  Lec- 
tures on  Anatomy,  to  a  class  of  twelve  students. 
He  continued  the  same  course  during  the  two 
following  years,  and  in  1765,  was  joined  by  John 
Morgan,  M.D.,  who   had  just  returned  from  an 
honorable  completion  of  his  medical  studies  in  the 
schools  of  Edinburgh.     Dr.  Morgan  soon   deli- 
vered  a  'public   discourse  on   "  the  Institution  of 
Medical  Schools  in  America,"  before  the  Trustees 
of  the  University  that  had  been  established  in 
Philadelphia,  and  proposed  a  plan  for  teaching  the 
various  branches  of  medical  science.     His  views 
were  warmly  seconded  by  the  Board  of  Trustees, 
who  soon  after  appointed  Dr.  Morgan  Professor 
of  Theory    and  Practice  of  Medicine,  and  Dr. 
Shippen    Professor    of  Anatomy    and    Surgery. 
The  remaining  chairs  were  not  filled  until   1768, 
when  Dr.  Adam  Kuhn  was  chosen  Professor  of 
Botany  and  Materia  Medica  ;  and  in  the  follow- 
ing year  Dr.  Benjamin  Rush  returned  from  Edin- 
burgh,   and    was     appointed,    to     the    Chair    of 
Chemistry.     Thus    organized,   the    first    medical 
school  in  America  continued  its  annual  courses 
of  instruction  to  an  increasing  number  of  students 
until  1777,  when  it  was  suspended  by  the  Revolu- 
tionary War.     To  give  a  still  better  idea  of  the 


MEDICAL    HISTORY.  25 

objects  and  regulations  of  this  school,  and  the 
liberal  views  of  its  founders,  we  will  quote  the 
following  rules  in  regard  to  studies  and  qualifica- 
tions, from  a  printed  circular,  addressed  by  Dr. 
John  Morgan  to  the  inhabitants  of  the  West 
Indies,  in  1772,  viz.: 

For  &  Bachelor's  Degree  in  Physic. 

•"  I.  It  is  required  that  such  students  as  have 
not  taken  a  Degree  in  Arts,  shall,  before  admission 
to  a  Degree  in  Physic,  satisfy  the  Trustees  and 
Professors  of  the  College,  concerning  their  know- 
ledge of  the  Latin  tongue,  and  in  such  branches 
of  Mathematics,  Natural  and  Experimental  Phi- 
losophy, as  shall  be  judged  requisite  to  a  Medical 
Education. 

"  II.  Each  student  shall  take  at  least  one  course 
in  Anatomy,  Materia  Medica,  Chemistry,  the 
Theory  and  Practice  of  Physic  and  Clinical 
Lectures,  and  shall  attend  the  practice  of  the 
Pennsylvdnia  Hospital  for  one  year;  and  then 
may  be  admitted  to  a  public  examination  for  a 
Bachelor's  Degree  in  Physic,  provided  that,  on 
previous  private  examination  by  the  Medical 
Trustees  and  Professors,  and  such  other  Trustees 
and  Professors  as  choose  to  attend,  such  student 
shall  be  judged  fit  to  undergo  a  public  examina- 
tion. 

2 


2f>  MEDICAL    HISTORY, 

"  III.  It  is  further  required  that  each  student, 
previous  to  obtaining  a  Bachelor's  Degree,  shali 
have  served  a  sufficient  apprenticeship  to  some 
respectable  Practitioner  in  Physic,  and  be  able  to 
make  it  appear  that  he  has  a  general  knowledge 
in  Pharmacy. 

For  a  Doctor's  Degree  in  Physic. 

"  I.  It  is  required  that  at  least  three  years  shall 
intervene  from  the  time  of  taking  the  Bachelor's 
Degree,  and  that  the  candidate  be  full  twenty-four 
years  of  ager  and  that  he  write  and  defend  pub- 
licly in  college,  a  Latin  Thesis  or  dissertation  on 
some  disease,  or  other  useful  medical  topic,  which 
shall  also  be  printed  at  his  own  expense, 

"  II.  The  above  scheme  of  a  Medical  Educa- 
tion is  upon  as  extensive  and  liberal  a  plan  as  in 
any  of  the  most  respectable  European  seminaries  ; 
and  the  utmost  care  is  taken  to  render  the 
Degrees  real  marks  of  honor — the  marks  of  only 
distinguished  learning  and  abilities.  A  good  medi- 
cal education  is  here  looked  upon  as  not  the  least 
useful  part  of  science.  As  it  is  both  a  noble  and 
extensive  branch  of  learning  -of  itself,  and  of  the 
utmost  importance  to  the  health  and  welfare  of 
society,  '  there  cannot  therefore  be  too  much 
encouragement  given  to  a  full  and  regular  attain- 
ment of  it.'  'Tis,  on  this  account,  one  great 


MEDICAL    HlSTORV.  27 

object  in  the  Philadelphia  College,  and  intended  to 
put  the  practice  of  physic  in  America  in  general, 
upon  a  respectable  and  beneficial  footing." — [See 
"  The  Address  and  Representation  of  Dr.  John 
Morgan,  of  the  College  of  Philadelphia,  ia  behalf 
of  the  Seminary,  dated  1772.] 

Such  were  the  views  and  objects  of  the  foun- 
ders of  the  first  hospital  and  college  in  America. 
The  rules  quoted  were  adopted  by  the  College  on 
May  12,  1767,  and  continued  in  full  force  until 
the  operations  of  the  College  were  suspended  by 
the  occupation  of  Philadelphia  by  the  British,  in 
1777.  During  this  period  the  Degree  of  Bachelor 
of  Physic  was  conferred  on  about  thirty  young 
men,  and  a  reasonable  degree  of  prosperity  seems 
to  have  attended  the  College.  But  while  these 
things  were  being  done  in  Philadelphia,  the  pro- 
fession in  New  York  were  not  idle.  The  zealous 
efforts  of  Drs.  Bard,  Middleton,  and  others,  aided, 
doubtless,  by  a  spirit  of  rivalry  with  Philadelphia, 
effected  the  organization  of  the  Society  of  the 
New  York  Hospital,  and  procured  for  it  a  charter 
from  the  Colonial  Government  in  1767.  The 
first  building  was  destroyed  by  fire  in  1772, 
which,  together  with  the  occupation  of  New 
York  by  the  British  army,  prevented  the  comple- 
tion of  another,  until  1791,  when  the  first  patients 


28  MEDICAL    HISTORY. 

were  received.  Their  efforts  to  establish  a 
medical  college  in  connection  with  King's  Col- 
lege, which  had  been  established  in  the  city  seve- 
ral years  previous,  was,  however,  attended  with 
better  success.  A  full  Medical  Faculty  was  or- 
ganized in  1768,  composed  of  Samuel  Glossy, 
M.  D.,  Prof,  of  Anatomy;  John  Jones,  M.  D., 
Prof,  of  Surgery;  Peter  Middleton,  M.  D.,  Prof, 
of  Physiology  and  Pathology ;  James  Smith, 
M.  D.,  Prof,  of  Chemistry  and  Materia  Medica ; 
John  V.  B.  Tennent,  M.  D,  Prof,  of  Midwifery ; 
and  Samuel  Bard,  M.  D.,  Prof,  of  Theory  and 
Practice  of  Physic.  The  first  courses  of  lectm'es 
were  given  in  the  winter  of  1768 — 9,  at  the  close 
of  which,  the  degree  of  Bachelor  in  Medicine 
was  conferred  upon  Samuel  Kissam  and  Robert 
Tucker ;  and  in  the  year  following,  the  same 
gentlemen  received  the  higher  degree  of  Doctor 
in  Physic.  These  are  stated  by  Dr.  Beck,  in  his 
"  History  of  American  Medicine  before  the  Re- 
volution," to  be  the  first  medical  degrees  con- 
ferred by  the  schools  in  America.*  But  this  is 
probably  a  mistake,  as  we  find  in  a  historical 
sketch  of  the  College  in  Philadelphia,  published 
in  1836,  the  names  of  ten  students,  who  received 
the  degree  of  Bachelor  of  Physic  at  the 


*  See  Transactions  of  the  Medical  Society  of  the  State  of 
New  York.— VoL  v.  pp.  141. 


MEDICAL    HISTORY.  29 

commencement  in  that  College,  in  June,  1768 ; 
and  a  number  of  others  were  annually  thereafter 
honored  with  the  same  degree,  until  the  opera- 
tions of  the  School  were  suspended  by  the  vicis- 
situdes of  war.  During  this  period  very  few 
seem  to  have  applied  for  the  higher  degree  of 
Doctor  in  Medicine,  either  in  Philadelphia  or 
New  York. 

We  have  no  means  of  ascertaining  what  rules 
were  adopted  for  the  government  of  the  College 
in  New  York;  or  what  were  the  requisites  for 
the  graduation  of  medical  students.  It  is  certain, 
however,  that  the  prosperity  of  the  school  was 
not  proportioned  to  the  known  respectability  and 
learning  of  the  professors.  Thus,  we  are  told  by 
Dr.  N.  Romaine,  that  in  1774,  six  years  after  its 
first  organization,  only  "  about  25  persons  at- 
tended the  Anatomical  Lectures,  some  of  whom 
were  students  from  the  West  Indies."  This  want 
of  prosperity  has  been  attributed  to  the  conduct 
of  the  governors  of  the  College ;  but  with  what 
justice,  we  are  entirely  unable  to  judge. 

The  medical  books  then  in  general  use,  were 
the  writings  of  Sydenham,  Boerhaave,  Van 
Swieten,  Mead,  and  Huxham ;  the  Physiology  of 
Haller ;  the  Anatomy  of  Cowper,  Cheselden,  and 
Munro ;  the  Surgery  of  Sharp,  Le  Dran,  and 
Pott ;  the  Midwifery  of  Hunter  and  Smellie  ;  and 


80  MEDICAL    HISTORY. 

the  Materia  Medica  of  Lewis.  But  though  the 
works  then  in  general  use  were  all  of  European 
production,  yet  medical  literature  had  by  no 
means  been  neglected  by  the  profession  in 
America,  as  the  following  list  will  show,  viz. : 

"  A  Brief  Guide  in  Small-Pox  and  Measles," 
by  Thomas  *Thatcher,  of  Massachusetts,  pub- 
lished, 1677.  "Some  Account  of  the  New  Me- 
thod of  Receiving  the  Small-Pox  by  Engrafting 
or  Inoculation,"*  defending  the  practice,  by  Benj. 
Colman,  of  Boston,  published  in  1721.  "An  Ac- 
count of  the  Climate  and  Diseases  of  New  York," 
by  Cadwallader  Golden,  of  New  York,  published 
in  1720.  "An  Historical  Account  of  the  Small- 
Pox  Inoculation  in  New  England,"  by  Dr.  Zab- 
diel  Boylston,  of  Boston,  published  in  1727.  "On 
the  Method  of  Practice  in  Small-Pox  in  1730," 
by  Nathaniel  Williams,  of  Massachusetts.  "A 
Treatise  on  Pharmacy  in  1732,"'  by  William 
Howard,  of  Mass.  "  An  Essay  on  Fevers,"  by 
Dr.  John  Walton,  of  Boston,  in  1732.  "  The 
Practical  History  of  a  New  Epidemical  Eruptive 
Military  Fever,  with  an  Angina  Ulcusculosa, 
which  prevailed  in  New  England  in  1735 — 6," 
by  Dr.  William  Douglass,  of  Mass.,  published  in 
1736.  "An  Essay  on  the  Polygala  Seneka,"  by 
Dr.  John  Tennent,  of  New  York,  published  1736. 
"  An  Essay  on  Illiac  Passion,"  by  Dr.  Thomas 


MEDICAL    HISTORY.  31 

Cadvvallader,  published  1740.  "  An  Essay  on  the 
Causes  of  the  Different  Colors  of  People  in  Dif- 
ferent Climates,"  and  "  Letters  on  the  Yellow 
Fever  of  Virginia,"  by 'Dr.  John  Mitchell,  of  Vir- 
ginia, published  1743.  ".The  Flora  Virginia," 
by  Dr.  John  Clayton,  of  Virginia,  published  1743. 
"  A  very  valuable  account  of  Statistical  Experi- 
ments concerning  Excretions  of  the  Human 
Body,"  by  Dr.  John  Lining,  of  South  Carolina, 
published  in  1743.  About  the  same  time,  Dr. 
Cadwallader  Golden,  of  New  York,  published 
"  Observations  on  the  Fever  which  prevailed  in 
the  City  of  New  York  in  1741  and  '42,"  also, 
"  On  the  Virtues  of  Great  Water  Dock,"  and  a 
"  Sore  Throat  Distemper  which  prevailed  Epi- 
demically in  this  country  in  1735."  "  A  descrip- 
tion of  American  Yellow  Fever,"  was  published 
by  Dr.  John  Lining,  in  1753  ;  and  a  paper  on 
"  Opisthotonos  and  Tetanus,"  by  Dr.  Lionel  Chal- 
mers, of  South  Carolina,  published  in  1754.  "An 
Essay  on  the  Use  of  Bark  in  Scrofulous  Cases," 
was  published  by  Dr.  Thomas  Bond,  of  Phila- 
delphia, in  1759;  also,  an  Inaugural  Disserta- 
tion, entitled,  "  Tentamen  Medicum  de  Puris 
Confectione,  Edinburgh,  1763."  by  Dr.  John  Mor- 
gan. Dr.  Shippen's  Inaugural  Thesis,  entitled  "De 
Placentae  Cum  Utero  Nexu,"  was  published  in 
1760;  and  during  the  same  year,  Dr.  John  Bard, 


&2  MEDICAL 

of  New  York,  published  a  case  of  "Extra  Uterine* 
Foetus,"  and  an  "  Essay  o-n  the  Nature  and  Cause 
of  the  Malignant  Pleurisy,"  which  prevailed  or* 
Long  Island  in  the  winter  of  1749-.  In  1771,  Dr, 
Samuel  Kissara  published  his-  Inaugural  Disserta- 
tion on  the  "  Anthelrointie  Virtue  of  the  Phaseo- 
lus  Zuratensis  Siliqua  Hirsuta,  or  Cowhage."  A 
valuable  work  on  the  "  Treatment  of  Wounds 
and  Fractures-,"  was  published  by  Dr.  John  Jones,, 
in  1776",  And  the  same  year  Dr,  Lionel  Chalmers- 
published  his  able  work  on  the  "  Weather  and) 
Diseases  of  South  Carolina."  "An  Essay  on 
Fevers  "  had  been  published  by  the  same  author 
in  1768. 

(Many  of  these  productions  are  characterized 
by  a  variety  of  learning,  an  accuracy  of  observa- 
tion, and  an  originality  of  thought,  which  would  do- 
credit  to  any  age  or  country,  j  Thus,  Dr.  Lining's- 
"  Description  of  American  Yellow  Fever,"  stands 
to  the  present  day,  unrivalled  for  its  accuracy  and 
minuteness  of  description  \  arid  Dr.  Douglass,  in 
his  "  History  of  the  New  Epidemical  Fever  "  of 
1735 — 6,  not  only  gives  the  best  account  of  that 
fatal  disease,  but  also  enjoys  the  honor  of  first 
suggesting  the  use  of  calomel  as  a  remedy.  Dr. 
Clayton's  "  Flora  Virginia  "  attracted  so  much 
attention  that  it  was  republished  at  Leyden, 
1762;  and  very  few  papers  exhibit  a  greater 


MEDICAL    HISTORY.  33 

degree  of  philosophical  acumen  and  learning  than 
Dr.  Mitchell's  on  the  "  Causes  of  the  Different 
Colors  of  Different  People."  Of  Dr.  Jones  and 
his  work  on  Wounds  and  Fractures,  Dr.  J.  B. 
Beck  speaks,  as  follows,  viz. :  "  The  only  work  he 
has  left  us  is  a  volume  upon  wounds  and  frac- 
tures, which  was  first  published  in  1776.  In  the 
situation  in  which  the  colonies  were  then  placed, 
this  was  a  most  acceptable  present,  both  to  the 
profession  and  to  the  public.  It  was  so  well  re- 
ceived, that  a  second  edition  was  called  for  the 
same  year.  Although  a  plain  and  unpretending 
work,  it  was  admirably  fitted  to  the  purposes  for 
•  which  it  was  intended,  and  it  shows  the  author 
to  have  been  a  man  of  strong  sense,  combined 
with  a  thorough  knowledge  of  his  subject.  Al- 
together, Dr.  Jones  has  left  behind  him  a  most 
enviable  reputation.  He  was  the  physician  of 
Washington  and  Franklin,  the  latter  of  whom  he 
attended  in  his  last  illness.  Not  merely  as  the 
skillful  operator,  but  as  the  scientific  surgeon,  and 
the  first  teacher  of  surgery  in  the  colonies,  he 
justly  deserves  to  be  styled  the  father  of  Ameri- 
can surgery."  The  work  of  Dr.  Chalmers  on 
the  Climate  and  Diseases  of  South  Carolina,  in 
two  volumes,  is  particularly  worthy  of  attention, 
as  well  as  that  of  the  same  character  concern- 
ing New  York,  by  Dr.  Golden.  And  the  credit 
2* 


84  MEftlCAL   HISTORY. 

of  originality,  in  promulgating  the  true  doctrine 
in  regard  to  the  formation  of  Pus,  though  usually 
ascribed  to  Dr.  John  Hunter,  undoubtedly  be- 
longs to  Dr.  John  Morgan,  who,  in  his  Inaugu- 
ral Thesis,  maintained  with  great  ability  the 
doctrine  that  Pus  is  a  Secretion.  This  is  fully 
and  honorably  acknowledged  by  Dr.  James  Curry, 
lecturer  at  Guy's  Hospital,  so  early  as  1817. 

Nor  is  this  the  only  instance  of  fair  claim  to 
originality,  which  has  been  appropriated  else- 
where. The  use  of  mercury  in  the  treatment  of 
inflammatory  diseases  and  eruptive  fevers  had  its 
origin  with  Dr.  Douglass,  of  Boston,  in  1736; 
the  preparation  used  was  calomel.  But  to  Dr. 
James  Ogden,  of  Long  Island,  are  the  profession 
indebted  for  pointing  out  more  systematically  the 
indications  for  its  use,  and  the  manner  of  using 
it.  He  used  it  extensively,  and  with  the  happiest 
effects,  in  the  Angina  Maligna  of  1749;  and  its 
use  was  rapidly  extended  to  the  treatment  of 
nearly  all  the  Phlegmasia. — Again,  to  Dr.  Richard 
Bayley,  are  we  indebted  for  first  pointing  out  the 
true  inflammatory  nature  of  the  Cynanche 
Trachealis,  or  Croup,  and  the  great  utility  of 
blood-letting  and  antimony  in  its  treatment.  Yet 
all  of  these  have  been  often  set  forth  as  originating 
on  the  other  side  of  the  Atlantic. 

Dr.  James    Llovd,   of    Mass.,    and    Dr.  Wm 


MEDICAL    HISTORY.  35 

Shippen,  of  Philadelphia,  were  the  first  regular 
and  successful  practitioners  of  Midwifery  in  this 
country.  The  one  settled  in  Boston  in  1754,  and 
the  other  in  Philadelphia  in  1756;  and  to  their 
skill,  boldness,  and  decision  of  character,  are  we 
indebted  for  the  rescue  of  that  most  delicate  and 
important  branch  of  practice  from  the  hands  of 
ignorant  and  credulous  females. 

Although  a  consideration  of  medical  practice 
does  not  come  strictly  within  the  scope  of  our 
present  work,  yet  an  occasional  glance  at  this, 
and  the  character  of  diseases  prevalent  at  differ- 
ent periods  of  time,  will  be  both  interesting  and 
profitable.  Indeed,  a  carefully  written  history  of 
diseases,  their  variations  of  type  and  severity,  in 
connection  with  the  prevalent  modes  of  medical 
practice,  and  the  ever-varying  customs  of  society, 
would  be  of  great  value  to  the  profession.  It 
would  explain  the  origin  of  many  theories  and 
systems  in  medicine,  and  reconcile  much  that  now 
seems  discordant  and  contradictory  in  our  medi- 
cal literature. 

Thus  says  Dr.  Rush : — "  The  success  of  nature 
in  curing  the  simple  diseases  of  Saxony,  laid  the 
foundation  for  the  Anima  Medico,  of  Stahl.  The 
endemics  of  Holland  led  Dr.  Bo3rhaave  to  seek 
for  the  causes  of  all  diseases  in  the  fluids.  And 
the  universal  prevalence  of  diseases  of  the  nerves 


36  MEDICAL    HISTORY. 

in  Great  Britain,  led  Cullen  to  discover  their 
peculiar  laws,  and  to  found  a  system  upon  them 
— a  system  which  will  probably  last  till  some  new 
diseases  are  let  loose  upon  the  human  species, 
which  shall  unfold  other  laws  of  the  animal 
economy." 

During  the  greater  part  of  the  period  included 
in  this  chapter,  the  Humoral  doctrines  of  Bcer- 
haave  held  an  unlimited  sway  over  the  minds  and 
practice  of  physicians,  both  in  this  country  and 
Europe.  Endemic  and  epidemic  fevers  prevailed 
frequently  in  nearly  all  the  colonies,  and  some- 
times produced  great  destruction  to  life.  This 
was  the  case,  to  some  extent,  even  among  the 
Indians,  before  white  settlements  were  formed. 
Thus,  we  are  told  by  Dermer.  Mather,  and 
Gookin,  that  in  1618 — 19,  a  pestilential  fever  pre- 
vailed among  the  Indians  in  New  England,  with 
such  severity  that  whole  tribes  were  nearly  de- 
stroyed ;  and  in  some  places,  in  1620,  their  dead 
bodies  were  found  unburied,  putrefying  in  the 
sun.  The  first  colony  of  Pilgrims  that  landed  at 
Plymouth,  in  1620,  suffered  dreadfully  from 
sickness  during  the  few  following  years.  And  in 
1632 — 33 — 38,  a  pestilence,  resembling  the  yel- 
low fever,  prevailed  extensively  in  the  New  Eng- 
land settlements,  which,  with  the  small-pox,  cut 
off  manv  of  the  inhabitants.  Dr.  Rush  tells  us 


MEDICAL    HISTORY.  37 

that  between  the  years  1760  and  1768,  intermit- 
ting, bilious,  and  yellow  fevers  were  common  in 
Philadelphia  and  its  environs;  that  influenza  was 
epidemic  in  1761,  and  the  malignant  sore  throat 
in  1763.  He  also  states  that  deaths  were  "com- 
mon between  the  fiftieth  and  sixtieth  years  of 
life,  from  gout,  apoplexy,  palsy,  obstructed  livers, 
and  dropsies." 

This  last  paragraph  is  worthy  of  a  moment's 
consideration.  Why  were  these  diseases  so  fre- 
quent and  fatal,  when,  thirty  years  after,  the  same 
author  tells  us  they  were  comparatively  rare  in 
the  same  city?  A  very  satisfactory  answer  to 
this  question  will  be  found  in  the  habits  of  the 
citizens  at  the  two  periods  referred  to.  Alluding 
to  these  habits  during  the  period  intervening  be- 
tween the  years  1760  and  1766,  Dr.  Rush  says 
"  the  diet  of  the  inhabitants  of  Philadelphia, 
during  those  years,  consisted  chiefly  of  animal 
food.  It  was  eaten  in  some  families  three  times, 
and  In  all  twice  a-day.  A  hot  supper  was  a 
general  meal.  To  two  and  often  three  meals  of 
animal  food  in  a  day,  many  persons  added  what 
was  then  called  '  a  relish '  about  an  hour  before 
dinner.  It  consisted  of  a  slice  of  ham,  a  piece 
of  salted  fish,  and  now  and  then  a  beef  steak, 
accompanied  with  large  draughts  of  punch  or 
toddy.  Tea  was  taken  in  the  interval  between 


38  MEDICAL    HISTORY. 

dinner  and  supper.  In  many  companies,  a  glass 
of  wine  and  bitters  was  taken  a  few  minutes  be- 
fore dinner,  in  order  to  increase  the  appetite. 
The  drinks,  with  dinner  and  supper,  were  punch 
and  table  beer.  Besides  feeding  thus  plentifully 
in  their  families,  many  of  the  most  respectable 
citizens  belonged  to  clubs,  which  met  in  the  city 
in  the  winter ;  and  in  its  vicinity,  under  sheds  or 
the  shades  of  trees,  in  the  summer,  once  or  twice 
a  week,  and,  in  one  instance,  every  night. 

"  They  were  drawn  together  by  suppers  in  win- 
ter, and  dinners  in  summer.  Their  food  was 
simple,  and  taken  chiefly  in  a  solid  form.  The 
liquors  used  with  it  were  punch,  London  porter, 
and  sound  old  Madeira  wine. 

"  From  this  general  use  of  distilled  and  fer- 
mented liquors,  drunkenness  was  a  common  vice 
in  all  the  different. ranks  of  society."*  Who  can 
feel  surprised  that,  in  the  midst  of  a  people  in- 
dulging in  such  habits,  death  from  "  gout,  apo- 
plexy, palsy,  obstructed  livers,  and  dropsies," 
should  be  remarkably  frequent  ? 

The  same  writer  tells  us  that  one  club,  "  con- 
sisting of  about  a  dozen  of  the  first  gentlemen  in 
the  city,  all  paid,  for  their  intemperance,  the  for- 
feit of  their  lives ;  and  most  of  them  with  some 


*  See  Rush  on  the  state  of  Medicine,  between  1760,  1766, 
and  1809. 


MEDICAL    HISTORY.  39 

one  or  more  of  the  diseases  that  have  been  men- 
tioned." 

These  few  facts  are  introduced  here,  for  the 
purpose  of  showing  how  poorly  we  are  qualified 
to  judge  of  the  propriety  of  any  system  of  prac- 
tice, at  a  given  period  of  time,  without  an  inti- 
mate acquaintance  with  the  condition  and  customs 
of  the  people  at  ihs  same  period. 

We  have  already  said  that  practitioners 
during  most  of  our  colonial  period,  were 
much  controlled  in  practice  by  the  doctrines 
of  Boerhaave  ;  but  during  the  latter  part 
of  the  time,  these  began  rapidly  to  yield  to 
the  advancing  school  of  Cullen.  There  were 
not  wanting,  however,  many  bold  and  inde- 
pendent practitioners,  who  did  not  hesitate  to 
throw  off  the  shackles  of  prevailing  systems,  and 
adapt  their  treatment  to  the  prevailing  type  or 
character  of  disease,  or  introduce  new  remedies, 
as  the  preceding  facts  abundantly  show.  Of 
these,  none  were  more  deserving  of  notice  than 
Drs.  Boylston,  Golden,  Ogden,  Bayley,  Morgan, 
and  Bond.  So  rapid  was  the  decline  of  the 
Bcerhaavian  influence,  that  before  the  close  of  the 
Revolutionary  War,  we  find  blood-letting,  purges, 
vomits,  bark,  opium,  and  mercury  all  used  with 
more  or  less  freedom  throughout  the  profession. 
The  last  named  remedy  was  extensively  and  very 


40  MEDICAL    HISTORY. 

successfully  used  by  some  physicians,  in  preparing 
the  system  for  the  small-pox,  both  in  the  natural 
way,  and  after  inoculation.  This  practice  .was 
commenced  as  early  as  1745,  by  Dr.  Thomas,  of 
Virginia,  and  Munson,  of  Long  Island.  And  by 
it,  we  are  told,  they  reduced  the  number  of  deaths 
after  inoculation  from  one  in  one  hundred  to  one 
in  eight  hundred  or  one  thousand.  Dr.  Zabdiel 
Boylston,  of  Boston,  first  introduced  the  practice 
of  inoculation  for  the  small-pox  into  the  country, 
by  inoculating  his  own  son,  thirteen  years  of 
age,  and  two  colored  servants.  This  was  on  the 
27th  of  June,  1721,  only  two  months  after  the 
inoculation  of  the  daughter  of  the  celebrated 
Lady  Wortley  Montague,  the  first  that  was 
practiced  in  England,  and  certainly  before 
any  knowledge  of  the  latter  case  could  have 
reached  Boston.  Dr.  Boylston  was  induced 
to  commence  the  practice  by  Rev.  Dr.  Cotton 
Mather,  who  had  read  an  account  of  the  inocula- 
tion in  Turkey,  published  in  the  transactions  of 
the  Royal  Society  of  London.  His  first  three 
experiments  proving  successful,  and  the  small- 
pox raging  fearfully  in  the  city  of  Boston,  Dr. 
Boylston  inoculated,  during  that  year,  247,  of  all 
ages  and  both  sexes,  and  39  were  inoculated  by 
other  physicians, — making  a  total  of  286,  of  whom 
only  six  died ;  while  of  5,759  who  were  attacked 


MEDICAL    HISTORY.  41 

with  it   in  the    natural  way,  during   the  same 
period,  844  died. 

It  is  not  strange  that,  when  this  practice  was 
first  introduced,  it  should  have  met  with  most 
violent  opposition,  requiring  no  small  degree  of 
firmness  and  perseverance,  on  the  part  of  those 
who  had  undertaken  it,  to  stem  the  torrent  of 
popular  indignation,  which  was  much  exasperated 
by  the  conduct  of  a  portion  of  the  profession,  at 
the  head  of  whom  was  Dr.  Wm.  Douglass,  a  man 
of  much  ab'lity  and  strong  prejudices.  Indeed, 
the  history  of  our  profession  brings  to  light  no 
controversy  of  a  more  exciting  and  violent  cha- 
racter, than  that  which  arose,  both  in  the  colonies 
and  the  mother  country,  from  the  introduction  of 
this  practice.  And  none  better  illustrates  the 
power  of  truth  to  triumph  over  error,  even  when 
entrenched  behind  the  strongest  bulwarks  of 
human  prejudice  and  passion ;  for  the  success  of 
Dr.  Boylston  rapidly  won  to  the  cause  intelligent 
members  of  the  profession,  and,  in  a  short  time 
the  practice  was  extended  through  all  the  colo- 
nies. And,  as  we  have  already  stated,  such  was 
the  success  attending  a  proper  preparation  of  the 
system  for  the  reception  of  the  disease,  that,  in- 
stead of  losing  six  out  of  two  hundred  and  eighty- 
six,  as  shown  during  the  first  year  of  its  intro- 
duction, in  less  than  twenty  years  after,  the 


42  MEDICAL    HISTORY. 

average  mortality  of  those  inoculated  did  not  ex- 
ceed one  in  eight  hundred.  Notwithstanding, 
the  popular  prejudice  which  was  excited  against 
Dr.  Boylston  was,  for  a  time,  strong  and  highly 
embittered,  yet  he  lived  to  receive  ample  com- 
pensation in  the  good  opinion  of  his  fellow-men, 
both  at  home  and  abroad.  He  afterwards  visited 
England,  and  besides  receiving  the  most  gratify- 
ing marks  of  attention,  he  had  the  honor  of  being 
the  first  physician  in  the  colonies  who  was  made 
a  member  of  the  Royal  Society  of  London. 

We  are  told  by  Dr.  J.  W,  Francis,  in  his 
Anniversary  Discourse  before  the  New  York 
Academy  of  Medicine,  that  Dr.  Beekman  Van 
Beuren,  as  physician  to  the  Alms  House,  in  the 
city  of  New  York,  "  was  the  first  physician  who 
introduced  the  practice  of  inoculation  for  the 
small-pox  in  our  public  institutions."  The  first 
post  mortem  examination  that  took  place  in 
America,  of  which  we  have  any  record,  was 
made  in  1691,  by  Dr.  Johannes  Kerf  by  1,  assisted 
by  five  other  physicians  of  the  city  of  New  York, 
The  body  examined  was  that  of  Governor 
Sloughter,  who  had  died  suddenly  under  suspi- 
cious circumstances.  It  was  not  until  1750, 
nearly  sixty  years  after,  that  the  first  human  body 
was  dissected,  for  the  purpose  of  imparting  medi- 
cal instruction  in  the  colonies.  This  was  clone 


MEDICAL    HISTORY.  43 

by  the  learned  Drs.  John  Bard  and  Peter  Middle- 
ton. 

The  study  of  Botany  also  received  attention 
from  some  of  the  earliest  and  most  learned  phy- 
sicians of  the  colonies.  Among  these  Drs.  Cad- 
wallader  Golden,  of  New  York,  and  John  Bar- 
tram,  of  Pennsylvania,  stood  pre-eminent.  The 
first  named  of  those  eminent  men  taught  the 
Linnaean  system  or  classification  of  plants,  on 
the  Banks  of  the  Hudson,  several  years  before  it 
was  recognized  in  England.  Golden  doubtless 
derived  his  knowledge  from  the  traveler,  Kalm, 
who  was  pupil  of  Linnaeus;  and  so  highly  was 
he  esteemed  by  the  botanists  of  the  Old  World, 
that  one  of  the  most  beautiful  plants  of  the  tetran- 
drous  class  was  named  Coldenia,  in  honor  of  his 
name. 

John  Bartram,  though  living  at  a  little  later 
period  of  our  history,  enjoyed  a  still  more  extens- 
ive reputation  in  this  department  of  science,  and 
probably  was  favored  .with  a  more  extensive 
correspondence  with  the  scientific  men  of  Europe 
than  any  of  his  cotemporaries.  He  was  the  first 
Anglo-American  who  attempted  to  establish  a 
botanic  garden  in  this  country.  This  garden  was 
located  on  the  Schuylkill,  about  three  miles  from 
Philadelphia,  and  contained  about  five  acres, 
well  covered  with  a  great  variety  "of  new, 


44  MEDICAL    HISTORY. 

beautiful,  and  useful  trees,  shrubs,  and  herbaceous 
plants." 

We  are  told  that  his  garden  attracted  the 
attention,  and  induced  the  visits  of  many  learned 
men  ;  and  Bartram  himself  continued  to  travel 
extensively  through  the  country,  and  make  collec- 
tions in  the  various  departments  of  natural  science, 
until  he  was  over  seventy  years  of  age. 

Dr.  John  Clayton,  who  came  from  England  to 
Virginia  in  1705,  has  already  been  referred  to  as 
the  author  of  the  Flora  Virginica,  published  in 
1743  ;  and  Dr.  Alexander  Garden,  of  South  Caro- 
lina, was  no  less  distinguished  both  as  a  naturalist 
and  physician.  He  kept  up  a  correspondence 
with  Linnaeus  in  Latin,  by  whom  he  was  held  in 
high  estimation.  The  beautiful  flowering  shrub 
called  Gardenia,  was  so  named  in  honor  of  Dr. 
Garden. 

The  practice  of  sending  native  young  men 
from  the  colonies  to  be  educated  in  the  Medi- 
cal Schools  of  Europe,,  was  more  prevalent  in 
the  southern  than  in  the  eastern  colonies.  So 
early  as.^1734,  William  Bull,  a  native^Carolinian, 
received  the  degree  of  M.D.  at  Leyden.  John 
Moultrie  graduated  at  Edinburgh,  in  1749,  and 
published  his  Thesis,  "  de  Febre  Flava  ;"  and  we 
are  told  by  Dr.  Ramsey,  that  ten  other  natives  of  • 
that  colony  obtained  the  same  honor  between 


MEDICAL    HISTORY.  45 

1768  and  1778.  In  the  middle  and  southern 
States,  there  was  much  less  disposition  to  merge 
the  duties  of  physician  and  priest  in  the  same 
hands,  than  in  New  England.  Indeed,  they  seem 
to  have  been  much  better  supplied  at  an  early  pe- 
riod, with  well  educated  physicians  from  England 
and  Scotland,  than  the  more  northern  colonies  ; 
and  in  the  same  proportion  did  the  profession  en- 
joy a  higher  reputation,  both  at  home  and  abroad. 
\^East  New  Jersey  appears  to  be  entitled  to  the 
credit  of  making  the  first  attempt  to  improve  the 
condition  of  the  profession  by  means  of  social  or- 
ganization.) So  early  as  1760,  a  numerous  meet- 
ing of  physicians  was  held  at  New  Brunswick, 
and  a  constitution  and  by-laws  adopted  for  a  per- 
manent organization.  Delegates  were  present 
from  all  parts  of  the  State,  and  the  objects,  as  set 
forth  in  the  preamble  to  the  constitution,  were 
"  Mutual  improvement,  the  advancement  of  the 
Profession,  the  promotion  of  the  public  good,  and 
the  cultivation  of  harmony  and  friendship 
among  their  brethren."  These  were  objects 
worthy  the  attention  of  enlightened  minds  ;  and 
they  seem  to  have  been  strictly  adhered  to,  and 
successfully  carried  out ;  the  society  meeting  reg- 
ularly twice  in  each  year,  until  interrupted  in 
1775,  when  not  a  few  of  its  members  left  the  so- 
cial circle  and  the  bed-side,  to  bind  up  the  wounds 


46  MEDICAL    HISTORY, 

of  bleeding  freemen,  or  with  them,  share  the 
deadly  strife  in  freedom's  cause.  The  second 
important  movement  in  this  direction,  was  in  the 
colony  of  Massachusetts,  a  little  before  the  close 
of  the  war.  In  1781,  the  Massachusetts  Medical 
Society  was  incorporated,  embracing  about  thirty 
members,  with  the  venerable  Edward  Holyoke, 
as  its  President.  Among  the  original  members, 
we  find  the  names  of  John  Warren,  Aaron  Dex- 
ter, Joseph  Fisk,  Edward  A.  Holyoke,  and  James 
Lloyd. 

During  the  same  year,  Dr.  John  Warren,  who 
was  then  surgeon  of  a  military  hospital  in  Boston, 
commenced  a  course  of  anatomical  lectures,  which 
were  the  first  of  which  we  have  any  account  in 
New  England.  They  were  continued  several 
years,  and  attended  by  many  of  the  students  of 
Harvard  University,  until  a  Medical  Faculty  was 
organized  in  connection  with  that  institution, 

Such  is  a  brief  view  of  medical  institutions  and 
practice,  during  the  colonial  period  of  our  history. 
(And  if  we  consider  the  condition  of  the  American 
colonies,  the  many  dependencies  on  the  mother 
country,  on  the  one  hand,  and  the  almost  con- 
stant aggressions  of  the  French  and  Indians,  on 
the  other,  the  scattered  state  of  the  population 
etc.,  we  doubt  whether  any  profession,  under  sim- 
ilar circumstances,  ever  progressed  with  greater 


MEDICAL    HISTORY.  47 

rapidity  than  the  medical  profession  of  the  colo- 
nies, during  the  twenty-five  years  succeeding  the 
middle  of  the  eighteenth  century,  j  Still  quackery, 
in  all  its  forms  and  guises,  was^verywhere  flou- 
rishing ;  and  the  profession  itself  destitute  of  that 
internal  organization  or  associated  effort  at  im- 
provement, which  is  so  necessary  to  high  respect- 
ability and  permanent  prosperity.  Even  the 
prohibitory  laws  of  1760,  in  New  York,  and  of 
1772,  in  New  Jersey,  seem  to  have  had  very  little 
influence  in  accomplishing  the  object  for  which 
they  were  designed,  viz. :  the  elevation  of  the  pro- 
fession, and  the  suppression  of  irregular  practice. 
But  the  time  of  their  continuance  before  the 
commencement  of  the  war  of  1775,  which,  for  a 
period  of  eight  years,  effectually  diverted  the  at- 
tention of  all  classes  from  all  other  subjects,  was 
too  short  to  allow  any  inference  of  value  to  be 
drawn  in  regard  to  their  success  or  failure.  Not- 
withstanding the  adverse  circumstances  in  which 
the  country  was  placed,  and  the  admitted  degra- 
dation of  a  great  proportion  of  the  medical  prac- 
tice of  those  times,  still  we  cannot  but  admire  the 
liberal  views,  the  close  and  patient  observation, 
and  the  bold  cast  of  originality,  exhibited  by  those 
whose  education  had  fitted  them  for  the  high  res- 
ponsibilities of  their  calling.  And  equally  must 
we  admire,  the  broad  and  liberal  basis  on  which 


48  MEDICAL    HISTORY. 

they  planted  their  infant  institutions  in  Philadel- 
phia and  New  York ;  requiring  as  they  did,  a 
preliminary  education  and  a  curriculum  of  medi- 
cal studies,  superior  to  that  of  any  medical 
institution  now  existing  in  our  boasted  republic. 
If,  any  doubt  this,  let  them  compare  the  regula- 
tions of  the  Philadelphia  Medical  College  of  1768, 
as  already  quoted,  with  those  of  any  of  our 
existing  institutions. 


CHAPTER  II. 

FROM  THE  YEAR  ONE  THOUSAND  SEVEN  HUNDRED 
AND  EIGHTY-THREE  TO  ONE  THOUSAND  EIGHT 
HUNDRED  AND»SIX. 

During  that  great  Revolutionary  struggle, 
which  terminated  in  the  establishment  of  the  In- 
dependence of  the  American  colonies,  but  little 
time  or  means  was  afforded  for  the  cultivation  of 
any  science  or  profession,  save  that  of  arms  and 
the  arts  of  w#r.  And  perhaps  no  class  were 
more  faithful  or  vigilant  in  their  country's  cause 
than  the  practitioners  of  medicine.  They  not 
only  followed  the  military  camp,  sharing  its  pri- 
vations and  toils  as  surgeons,  but  no  small  num- 
ber exchanged  the  lancet  for  the  sword,  and  the 
Esculapian  wig  for  the  cap  of  the  military  chief; 
and  long  will  the  pages  of  American  history  glow 
with  the  names  of  Warren,  Mercer,  Rush,  etc., 
the  two  former  of  whom  sealed  their  devotion  to 
the  cause  with  their  lives.  "During  the  war,  both 
New  York  and  Philadelphia  fell  into  the  hands  of 


50  MEDICAL    HISTORY, 

the  British,  and  the  operations  of  the  medical 
schools,  like  all  other  institutions  in  those  places, 
were  suspended  until  their  evacuation.  Evert 
the  Medical  Society  of  New  Jersey,  as  already 
stated,  was  compelled  to  suspend  its  functions 
during  the  hostile  incursions  of  the  proud  invader, 
But,  while  these  ordinary  means  of  facilitating 
medical  education  were  suspended,  another  school 
of  quite  a  different  character  was  opened  for  the 
training  of  our  profession.  We  have  alluded,  in 
a  previous  chapter,  to  the  benefits  derived  by  the 
profession  of  the  Colonies  from  the  medical  corps 
attached  to  the  English  armies,  sent  against  the 
French  colonies  in  the  war  which  terminated  in- 
1763 ;  but  the  war  for  Independence  afforded 
another  and  severer  school  than  the  one  which 
had  preceded.  In  the  former,  the  Colonial  pro- 
fession held  the  position  of  pupils  and]  assist- 
ants, while  in  the  latter  they  were  left  entirely 
to  their  own  resources,  in  a  direct  contest  against 
their  former  guides  and  masters.  It  was  during 
this  trying  period,  when  the  profession  was  com- 
pelled to  act  independently,  and  often  without 
even  a  proper  supply  of  drugs,  that,  animated  and 
encouraged  by  the  noble  spirit  of  a  Rush,  it  rose 
equal  to  every  emergency,  and  acquired  that  self- 
reliance  which  enabled  it,  at  the  close  of  the 
eventful  struggle,  to  set  about  resuscitating  its 


MEDTCAt,    HISTORY.  51 

infant  institutions,  with  a  zeal  that  could  not  fail 
of  success.  Hence,  no  sooner  was  Philadelphia 
evacuated  by  the  British  army  in  1778,  than  we 
find  the  functions  of  the  College  and  Hospital 
resumed  by  the  same  teachers,  and  under  the 
same  regulations,  as  before.  The  number  of 
students  in  attendance  during  the  winter  and 
spring  of  1779,  was  not  less  than  sixty,  although 
no  graduates  are  reported  for  that  year.  Indeed, 
the  number  of  graduates  during  the  whole  of  the 
period  under  consideration,  amounting  to  nearly 
a  quarter  of  a  century,  scarcely  averaged  ten 
annually.  This  was  neither  owing  to  the  small 
number  of  students  in  attendance  on  the  lectures, 
nor  to  the  difficulties  in  the  way  of  graduation, 
but  to  the  much  less  relative  importance  which 
was  at  this  period  attached  to  the  degree.  The 
degree,  either  of  Bachelor  of  Medicine,  or 
Doctor,  conveyed,  at  that  time,  no  special  privi- 
leges in  regard  to  practice  ;  and  hence  was  re- 
garded, like  all  other  literary  degrees,  as  a  mere 
honorary  title, — therefore,  we  find  students  resort- 
ing to  the  Medical  College,  not  so  much  for  the 
title  it  was  authorized  to  bestow,  as  for  the  real 
medical  knowledge  it  was  capable  of  dispensing. 
In  1779,  the  Pennsylvania  legislature  abro- 
gated the  charter  of  the  College,  and  founded 
another,  called  the  University  of  Pennsylvania, 


52  MEDICAL  HISTORY. 

endowing  it  liberally  "with  funds  derived  from  the 
confiscated  estates  of  the  royalists  of  that  com- 
monwealth, and  providedobr  a  medical  depart- 
ment in  place  of  that  in  connection  with  the  one 
whose  organization  had  been  dissolved. 

This,  however,  produced  but  little  other  effect 
on  the  Medical  College  than  a  change  of  name, 
for  the  same  professors  were  in  reality  continued, 
until  1789,  when  the  legislature,  acknowledging 
the  injustice  of  their  predecessors  in  abrogating 
the  former  charter,  restored  it  again,  with  all  the 
powers  and  privileges  belonging  thereto ;  but,  at 
the  same  time,  permitting  the  University  to  re- 
main unaltered.  This  act  brought  into  existence 
two  Colleges,  each  possessed  of  the  privilege  of 
having  a  medical  department  annexed,  and  neither 
willing  to  forego  that  privilege  in  favor  of  the 
other. 

The  result  was  the  organization  of  two  medi- 
cal faculties  during  the  following  year.  But  ex- 
perience soon  taught  them  that  the  patronage 
was  too  limited  to  sustain  two  institutions,  either 
literary  or  medical,  hence  they  were  united  in 
1792,  under  the  name  of  the  University  of  Penn- 
sylvania, which  has  been  retained  until  the  pre- 
sent time.  The  Medical  Faculty  of  the  united 
school  was  composed  of  Dr.  William  Shippen, 
Prof,  of  Anatomy,  Surgery,  and  Midwifery;  and 


MEDICAL    HISTORY.  53 

Dr.  Caspar  Wistar,  Adjunct;  Dr.  Adam  Kuhn, 
Prof,  of  Theory  and  Practice  of  Medicine;  Dr. 
Benjamin  Rush,  Prof,  of  the  Institutes  of  Medi- 
cine, and  Clinical  Medicine ;  Dr.  James  Hutch- 
inson,  Prof,  of  Chemistry ;  Dr.  Samuel  P.  Griffitts, 
Prof,  of  Materia  Medica;  Dr.  Benjamin  S.  Bar- 
ton, Prof,  of  Botany  and  Natural  History. 
Some  important  changes  were  also  made  at  this 
time  for  the  government  of  the  College,  and  the 
conferring  of  degrees.  The  Bachelor's  degree 
was  wholly  abolished,  and  that  of  Doctor  of 
Medicine  conferred  under  the  following  rules, 
viz.: 

"  1.  That  the  candidate  should  riot  be  under 
twenty-one  years  of  age,  should  have  studied 
medicine  for  three  years,  and  for  two,  at  least,  in 
connection  with  the  University.  2.  That  he 
should  have  attended  at  least  one  course  of  lec- 
tures of  the  several  professors,  with  the  exception 
of  the  professor  of  Botany  and  Natural  History, 
and  should  also  have  attended  one  course  of 
Natural  and  Experimental  Philosophy  in  the  in- 
stitution, unless  he  had  received  instruction  in 
this  branch  elsewhere;  and  3.  That  he  should 
undergo  a  private  examination  before  the  faculty; 
and  if  approved  by  them,  should  be  again  pri- 
vately examined  by  the  faculty,  in  the  presence 
of  as  many  of  the  trustees  as  might  choose  to 


54  MEDICAL    HISTORY. 

attend  ;  and  finally,  if  found  to  be  properly  quali- 
fied, should  offer  a  thesis,  to  be  printed  at  his  own 
expense,  and  defended  in  public  at  the  Annual 
Medical  Commencement."* 

No  one  can  fail  to  mark  the  contrast  between 
these  requisitions  and  those  adopted  by  the  first 
College,  in  1768.  Hei'e,  instead  of  a  preliminary 
education,  embracing  mathematics,  the  natural 
sciences,  and  some  knowledge  of  the  Latin  lan- 
guage, we  have  a  simple  requirement  in  regard  to 
some  instruction  in  "Natural  and  Experimental 
Philosophy  ;"  and,  indeed,  the  whole  requisitions 
for  the  degree  of  Doctor  of  Medicine,  are  much 
below  those  previously  required  for  that  of 
Bachelor.  And  we  may  here  date  the  commence- 
ment of  that  lowering  policy,  and  that  disregard 
of  preliminary  education  on  the  part  of  medical 
schools,  which  has  worked  great  injury  to  the 
profession.  But  why  was  the  original  standard 
departed  "from,  and  particularly  in  the  downward 
direction  ?  Before  answering  this  question,  we 
will  turn  our  attention  to  the  condition  of  medi- 
cine in  the  neighboring  city  of  New  York. 

Soon  after  the  close  of  the  war,  attempts  were 
made  to  revive  the  medical  department  of  King's 
(now  changed  to  .that  of  Columbia)  College. 


*  See  "  An   Historical  Sketch   of  the    University  of  Penn- 
sylvania," published  1836. 


MEDICAL    HISTORY.  55 

Through  some  mismanagement,  the  attempt  not 
only  failed,  but  was  attended  with  some  circum- 
stances which  gave  rise  to  a  strong  popular  out- 
break, commonly  called  the  "Doctor's  Mob."  This 
arose  from  a  suspicion  that  some  bodies  had  been 
stolen  from  the  grave-yard  for  dissection.  The 
mob  broke  into  the  dissecting  room  of  the  Col- 
lege, and'finding  several  subjects  partially  dis- 
sected, they  exhibited  the  fragments  to  the 
multitude  without,  which  so  increased  the  excite- 
ment, that  all  law  and  order  were  trampled  under 
foot  for  two  or  three  days.  Several  medical 
gentlemen  were  grossly  insulted,  and  many  of  the 
students  were  confined  in  prison  for  personal 
safety.  This  unhappy  event  not  only  tended 
very  much  to  degrade  the  profession  in  the  public 
estimation,  but  also  greatly  to  retard  the  progress 
of  the  College. 

To  counteract,  as  far  as  possible,  the  evil  in- 
fluences brought  to  bear  on  the  profession,  and 
to  improve  medical  science,  several  of  the  more 
enlightened  vouns;  members  formed  themselves 

O  * 

into  a  private  society  ;  and  in  1787,  they  suc- 
ceeded in  inducing  the  magistrates  of  the  city  to 
establish  an  apothecary's  shop,  at  the  public 
expense,  and  freely  tendered  their  professional 
services  for  the  sick  poor.  Among  the  more  pro- 
minent of  these  men  were  Drs.  Wm.  Moore, 


56  MEDICAL    IHSTOEY. 

Nicholas  Romaine,  Benjamin  Kissam,  Wright 
Post,  and  Valentine  Seaman.  They  not  only 
gave  gratuitous  attendance  on  the  poor  for  seve- 
ral years,  but  connected  therewith  lectures  on 
most  of  the  branches  of  medicine,  thereby  con- 
stituting the  first  real  hospital  and  dispensary, 
connected  with  practical  instruction,  under  the 
corporation  of  the  city.  So  great  was  their  suc- 
cess, that  in  1790,  more  than  fifty  students 
attended  their  instructions.  Encouraged  by  their 
success,  and  failing  in  the  establishment  of  a 
College  of  Physicians  and  Surgeons,  for  the  sole 
purpose  of  medical  instruction,  another  effort  was 
made  to  revive  the  medical  department  oi 
Columbia  College.  In  the  fall  of  1791,  the  pri- 
vate association  introduced  no  less  than  sixty 
medical  students  into  the  College,  and  thereby  in- 
duced the  legislature  to  make  a  grant  of  ove-i 
$30,000  to  the  trustees,  for  the  purpose  of  enabl- 
ing them  to  enlarge  their  buildings,  etc.  In  the 
following  year,  the  medical  faculty  was  re- 
organized, by  the  appointment  of  Drs.  Baily, 
Post,  Rogers,  Hamersly,  Nicoll,  and  Kissam, 
Professors ;.  and  Dr.  Bard,  Dean  of  the  Faculty, 
Some  of  these  appointments  were  so  unsatis- 
factory to  the  students  that  many  of  them  aban- 
doned the  College,  and  erased  their  names  from 
the  register.  Indeed,  such  were  the  internal 


MEDICAL    HISTORY.  57 

jealousies,  and  outward  prejudices,  that  the  insti- 
tution, though  it  maintained  an  existence  until 
1810,  yet  never  attained  a  degree  of  prosperity 
equal  to  the  private  association  to  which  we  have 
alluded.  About  this  time  also,  the  buildings  for 
the  New  York  Hospital,  which  had  been  destroyed 
by  fire  previous  to  the  war,  were  again  so  far 
completed  as  to  allow  of  the  admission  of  patients. 
Soon  after  the  close  of  the  war,  the  subject  of 
medical  instruction  began  to  attract  attention  in 
the  Eastern  States.  And  we  have  already  seen 
that  so  early  as  1782,  some  courses  of  lectures  on 
the  different  branches  of  medicine  were  given,  in 
connection  with  Cambridge  University.  This  was 
mainly  in  consequence  of  several  liberal  dona- 
tions from  some  wealthy  and  enlightened  friends 
of  the  cause.  In  1788,  a  medical  faculty  was 
established  in  connection  with  Harvard  College, 
headed  by  Dr.  John  Warren,  with  Drs.  Water- 
house  and  Dexter  for  associates.  This  was  con- 
tinued with  a  reasonable  degree  of  success,  and 
under  fair  regulations,  until  1810,  when  it  was 
removed  to  Boston,  where  it  soon  obtained  a  much 
higher  degree  of  prosperity.  How  much  the 
almost  simultaneous  establishment  of  these  several 
schools,  and  particularly  the  school  and  hospital 
in  the  rival  city  of  New  York,  influenced  the 

marked   lowering  down  of  the  requisitions   for 

3* 


68  MEDICAL   HtSTQSY. 

graduation,  to  which  we  have  alluded,  in  the 
Medical  School  of  Philadelphia,  every  reader  must 
judge  for  himself.  It  was  doubtless  these  things, 
aided  by  the  prevailing  spirit  of  the  times,  that  led 
to  this  sad  change  of  policy. 

The  Massachusetts  Medical  Society  was  estab- 
lished by  an  act  of  the  legislature  of  that  state  in 
1781.  The  objects  set  forth  in  the  act  of  incor- 
poration were,  the  promotion  of  medical  science, 
and  the  regulation  of  all  matters  pertaining  to  the 
profession.  To  enable  it  to  accomplish  these  de- 
sirable objects,  the  society  was  authorized  to  ap- 
point a  Board  of  Censors,  whose  duly  it  was  to 
examine  all  candidates  for  admission  into  the  pro- 
fession in  that  state,  and  grant  licenses  to  such  as 
were  found  qualified.  This  society,  together  with 
that  formed  soon  after  in  New  Haven,  and  the 
New  Hampshire  Society,  chartered  in  1791,  ex- 
erted a  very  salutary  influence  over  the  profession 
throughout  the  Eastern  States.  Their  powers  and 
duties  were  modified  from  time  to  time,  until  at 
length  the  organization  of  each  became  complete, 
and  they  had  severally  adopted  fixed  regulations 
for  the  examination  and  admission  of  candidates, 
and  enlightened  codes  of  medical  ethics,  as  we 
shall  see  in  the  sequel. 

To  stimulate  into  action  individual  talent,  and 
encourage  still  further  the  cultivation  of  medical 


MEDICAL    HISTORY'.  59 

science,  a  wealthy  and  enlightened  citizen  of 
Boston,  Ward  Nicholas  Boylston,  Esq.,  established 
in  1798,  a  perpetual  legacy,  yielding  $133  per  an- 
num. Thirty-three  dollars  of  this  sum  was  to  aid 
in  the  establishment  of  an  anatomical  museum, 
and  the  remaining  one  hundred  to  be  awarded 
annually  for  premiums  for  medical  essays,  under 
the  direction  of  the  Fellows  of  the  Massachusetts 
Medical  Society.  The  noble  intentions  of  the 
donor  have  been  faithfully  carried  out  by  the  so- 
ciety, who  have  thereby  annually  called  forth  a 
number  of  interesting  essays,  which  now  embrace 
many  of  the  most  important  topics  belonging  to 
medical  science.  The  Massachusetts  Medical 
Society  also  enjoys  the  honor  of  being  the  first  in 
this  country  to  issue  a  regular  volume  of  transac- 
tions, made  up  of  the  most  interesting  papers  read 
before  the  society. 

The  first  number  of  the  transactions  was  pub- 
lished previous  to  the  year  1800,  and  contained 
papers  written  by  Drs.  E.  A.  Holyoke,  of  Salem  ; 
Wm.  Baylies,  of  Dighton ;  Joseph  Orne,  of  Sa- 
lem ;  N.  W.  Appleton,  of  Boston ;  Edward  A. 
Wyer,  of  Halifax,  N.S. ;  Isaac  Rand,  of  Cam- 
bridge ;  Isaac  Rand,  Jr.,  of  Boston ;  Joseph  Os- 
good,  of  Andover;  Thomas  Welsh,  of  Boston; 
and  Thomas  Kast,  of  Boston.  The  most  import- 
ant of  these  papers,  were :  "  An  account  of  the 


60  MEDICAL    HISTORY. 

weather  and  epidemics  of  Salem,  in  the  county  of 
Essex,  for  the  year  1786  ;  with  a  bill  of  mortality 
for  the  same*  year ;  by  Edward  A.  Holyoke, 
M.D.,  written  in  1787," — "A  case  of  Empyema, 
successfully  treated  by  an  operation,  by  Isaac 
Rand,  in  1783," — "  Observations  on  Hydrocepha- 
lus  Internus,  by  operation,  by  Isaac  Rand,  Jr.,  in 
1789," — and  "  an  account  of  an  Aneurism  of  the 
Thigh  perfectly  cured  by  an  operation,  and  the 
use  of  the  limb  preserved,  by  Thomas  Kast,  in 
1790."  The  second  number  of  the  society's 
transactions  was  not  published  until  1808.  The 
first  medical  society  organised  south  of  New 
Jersey,  was  the  Philadelphia  College  of  Physicians, 
which  was  instituted  in  1787,  and  incorporated 
by  the  legislature  of  the  state  in  1789,  The 
Philadelphia  Medical  Society  was  organized  in 
the  same  city  in  1789,  and  was  incorporated  in 
1792.  An  interesting  notice  of  the  history  of  the 
last-named  society,  may  be  found  in  the  Medical 
News  and  Library  for  January,  1843. 

It  was  during  the  period  under  consideration 
that  another  powerful  means  of  diffusing  medical 
knowledge,  and  promoting  the  welfare  of  the  pro- 
fession, was  brought  into  requisition.  I  allude  to 
the  medical  periodical  press.  The  first  medical 
periodical  published  in  America,  was  commenced 
in  the  citv  of  New  York,  and  was  called  the 


MEDICAL    HISTORY.  61 

Medical  Repository.  It  was  commenced  by  Drs, 
Samuel  L.  Mitchell,  Edward  Miller,  and  Elihu  H. 
Smith,  in  1797 ;  and  the  first  named  of  this  eminent 
trio  continued  its  principal  editor  through  the 
whole  of  the  first  sixteen  volumes.  At  the  end  of 
this  time  it  passed  under  the  editorial  care  of  Dr. 
James  R.  Manley,  assisted  by  able  associates,  who 
maintained  its  reputation  unabated  until  the  end 
of  the  twenty-third  volume.  The  Repository 
was  a  good  sized  quarterly  journal,  and  its  pages 
were  enriched  with  many  of  the  ablest  medical 
and  scientific  productions  of  the  period  through 
which  it  was  published.  In  1804,  two  medical 
journals  were  started  in  Philadelphia,  one  called 
the  Philadelphia  Medical  Museum,  the  other,  the 
Philadelphia  Medical  and  Physical  Journal. 

The  first  number  of  the  Museum  was  issued  in 
September.  1804,  edited  by  Dr.  John  Redman 
Coxe.  The  Medical  and  Physical  Journal  was 
commenced  in  November  of  the  same  year,  under 
the  editorial  management  of  Benj.  Smith  Barton. 
These  several  journals  soon  called  into  action 
much  talent  that  had  hitherto  been  dormant,  by 
eliciting  essays  and  communications  from  many 
of  the  most  intelligent  members  of  the  profession 
in  every  part  of  the  country,  by  publishing  the 
proceedings  of  medical  societies  at  home  and 
abroad,  and  by  affording  a  free  channel  for 


G2  MEDICAL    HISTORY. 

dignified  scientific  discussions.  They  thus  became 
powerful  auxiliaries  in  the  great  work  of  medical 
education  and  advancement. 

The  medical  department  of  Dartmouth  College 
was  organized  in  1797,  on  much  the  same  plan 
with  the  first  schools  in  Philadelphia  and  New 
York.  During  the  first  nine  years  after  the  medical 
department  was  established,  medical  honors  were 
conferred  on  thirty-three  candidates,  only  one  of 
whom  took  the  higher  degree  of  Doctor  of  Medi- 
cine, all  the  rest  taking  the  degree  of  Bachelor. 
The  same  course  was  continued  up  to  1812,  after 
which,  the  degree  of  Doctor  seems  to  have  been 
the  only  one  conferred  by  the  college.  During 
the  period  now  under  consideration,  we  find  very 
little  done  by  the  several  state  legislatures,  either 
to  promote  the  education  of  the  profession,  or  pro- 
tect the  interests  of  the  community  against  em- 
piricism. The  first  legislaiive  act  which  we  find 
on  record,  having  for  its  object  the  regulation  of 
medical  practice,  subsequent  to  the  war,  was 
adopted  by  the  legislature  of  New  York,  in  March, 
1792.  This  law  required  all  students  who  had 
graduated  at  some  literary  college  in  the  United 
States,  to  study  two  years,  and  those  who  had  not 
so  graduated,  to  study  three  years  with  some  repu- 
table practitioner  ;  and  then  undergo  an  examina- 
tion before  the  Governor,  Chancellor,  the  judges 


MEDICAL    HISTORY.  C3 

of  the  Supreme  Court,  the  Attorney-General,  the 
Mayor,  and  Recorder  of  the  city  of  New  York,  or 
any  two  of  them.  The  examining  officers  were 
allowed  to  take  to  their  assistance  any  three  prac- 
titioners whom  they  might  choose ;  and  if  the 
candidate  was  found  qualified,  he  received  a  li- 
cense, which  authorized  him  to  practice  medicine 
in  all  its  branches.  But  all  persons  destitute  of 
such  license,  were  prohibited  from  collecting  pay 
for  their  services,  except  such  as  were  already  in 
practice  before  the  law  was  enacted.  This  law 
was  in  all  respects  similar  to  the  colonial  law  of 
1760  ;  and,  like  it,  was  limited  in  its  operations  to 
the  city  and  county  of  New  York.  The  act  con- 
tinued in  force  five  years,  when  it  was  repealed, 
or  rather  superseded,  by  another  passed  by  the 
legislature  in  1797,  which  prohibited  all  per- 
sons from  practicing  physic  or  surgery  in 
that  state  without  a  license  from  one  or  more 
of  the  officers  mentioned  in  the  act  of  1792, 
under  a  penalty  of  twenty-five  dollars  for  each 
offense. 

The  period  of  study  was  extended  to  four  years, 
with  a  deduction  of  one  year  in  favor  of  those 
who  had  graduated  at  some  literary  college.  Each 
candidate  was  also  required  to  furnish  the  exam- 
ining officers  with  a  certificate  of  the  time 
he  had  studied,  verified  by  the  oath  of  his 


64  MEDICAL    HISTORY. 

preceptor  ;  and  his  license  was  to  be  filed  in  the 
clerk's  office  of  the  county,  where  he  commenced 
practice. 

Those  who  had  received  the  degree  of  Bachelor 
or  Doctor  of  Medicine  from  a  medical  college, 
were  permitted  to  practice  on  filing  a  copy  of 
their  diploma  in  the  county  clerk's  office,  without 
any  further  examination.  The  great  defect  in 
this  law,  consisted  in  the  fact,  that  the  certificate, 
setting  forth  the  time  of  study,  etc.,  and  verified 
by  the  oath  of  the  preceptor,  became  the  only  test 
of  qualifications  for  practice  ;  it  being  only  neces- 
sary to  exhibit  this  to  the  proper  officer,  and  file 
it  in  the  office  of  the  county  clerk.  It,  however, 
remained  with  only  slight  amendment  until 
1806,  and  its  provisions  embraced  the  whole 
state. 

The  medical  society  which  had  existed  in  New 
Jersey  since  1766,  was  regularly  incorporated  by 
the  legislature  of  that  state,  in  1790,  under  the 
name  of  the  "  Medical  Society  of  the  state  of 
New  Jersey."  The  act  of  incorporation  conferred 
the  power  to  appoint  censors  for  the  purpose  of 
examining  and  licensing  candidates  for  permission 
to  practice  in  that  state  ;  also,  to  establish  district 
or  county  societies,  whose  delegates  were  to  con- 
stitute the  parent  or  state. society.  The  term  of 
study  required,  and  all  the  regulations  adopted, 


MEDICAL    HISTORY.  65 

were  very  similar  to  those  prescribed  by  the 
law  of  1797,  in  New  York.  The  Medical  Society 
of  South  Carolina  was  incorporated  in  1794,  but 
no  provision  for  examining  and  licensing  candi- 
dates for  admission  into  the  profession,  was  made 
until  1817. 

In  1799,  the  "  Medical  and  Chirurgical  Faculty 
of  the  state  of  Maryland  "  was  incorporated,  with 
power  to  elect  "  by  ballot,  twelve  persons  of  the 
greatest  medical  and  chirurgical  abilities  in  the 
state,  who  shall  be  styled  the  Medical  Board  of 
Examiners  for  the  state  of  Maryland."  It  was 
the  duty  of  this  board  "  to  grant  licenses  to  such 
medical  and  chirurgical  gentlemen,  as  they,  either 
upon  a  full  examination,  or  upon  the  production 
of  diplomas  from  some  respectable  college,  may 
judge  adequate  to  commence  the  practice  of  the 
medical  and  chirurgical  arts." 

Under  a  supplementary  act  passed  in  1801,  the 
Board  of  Examiners  required  all  graduates  of  me- 
dical colleges,  as  well  as  others,  to  apply  for  and 
obtain  a  license  before  being  authorized  to  prac- 
tice. The  penalty  for  practicing  in  violation  of 
the  foregoing  provisions,  was  fifty  dollars  for  each 
offense,  to  be  recovered  in  the  county  court  where 
the  offender  may  reside ;  and  the  judges  of  those 
courts  were  directed  to  give  the  several  acts  re- 
lating to  medicine  and  surgery,  annually,  in  charge 


68  MEDICAL    HISTORY". 

to  their  respective  grand  juries.*  Every  person  li- 
censed by  the  Examining  Board  was,  by  virtue  of 
such  license,  constituted  a  member  of  the  state  so- 
ciety. It  is  thus  seen  that  Maryland  was,  not  only 
among  the  earliest  to  enact  laws  to  protect  her  citi- 
zens against  the  inroads  of  ignorance  and  empiri- 
cism, but  also  that  her  laws  relating  to  this  subject 
were  at  once  simple  and  effectual.  By  the  foregoing, 
it  will  be  seen  that  six  of  the  original  thirteen 
states  had  recognized  their  right  and  duty  to  legis- 
late on  the  subject  of  medical  education  and  prac- 
tice during;  the  first  twenty  years  after  the  Revo- 

O  v      -/ 

lutionary  War. 

Concerning  the  general  condition  of  the  profes- 
sion at  this  time,  we  have  the  testimony  of  some 
of  its  most  distinguished  members,  as  well  as  other 
authority  of  a  reliable  character.  In  the  preamble 
to  the  law  passed  by  the  legislature  of  New  York, 
in  1792,  it  is  stated  that."  many  ignorant  and  un- 
skillful persons  presume  to  practice  physic  and 
surgery  within  the  city  and  county  of  New  York, 
to  the  great  detriment  and  hazard  of  the  lives  and 
limbs  of  the  citizens  thereof,"  etc.  And  the 
venerable  Dr.  John  Stearns,  in  speaking  of  this 
period,  says  :  "  those  who  witnessed  the  original 
and  progressive  settlement  of  the  northern  and 


*  See  act  of  Incorporation,  Supplementary  Acts,  &c.,  18mo 
Bait..  1822. 


MEDICAL    HISTORY.  67 

western  sections  of  this  (New  York)  state  since 
the  year  1791,  will  recognize  the  mania  that  in- 
fatuated the  emigrants  from  the  east,  and  the  am- 
bitious projects  formed  by  those  who  assumed  the 
title  of  Doctor.  Many  who  had  never  read  a 
volume  in  medicine,  were  suddenly  introduced  to 
an  extensive  practice,  and  to  a  reputation  of  such 
imposing  authority,  as  to  control  the  opinions  of 
their  superiors  in  science,  and  to  prescribe  rules 
of  practice  for  their  government.  Consultations 
were  generally  distinguished  for  gross  controver- 
sies at  the  bed-side  of  the  patient,  whose  health 
and  life  were  often  immolated  to  the  ignorance, 
prejudices,  or  discordant  theories  of  the  contend- 
ing physicians.  Their  skill  was  generally  gradu- 
ated by  their  ability  to  magnify  the  cures  they  had 
made."  *  Again  the  same  writer,  in  an  anniver- 
sary address  read  to  the  Medical  Society  of  the 
state  of  New  York,  in  1818,  says  :  "Science  was 
almost  exclusively  limited  to  our  populous  cities. 
With  a  few  honorable  exceptions  in  each  county, 
the  practitioners  were  ignorant,  degraded,  and 
contemptible.  Without  any  system  of  principles, 
their  practice  was  desultory  and  empirical."  Al- 
though the  foregoing  extracts  were  written  solely 
in  reference  to  the  profession  in  the  state  of  New 


*  See  United  States  Medical  and  Surgical  Journal,  No.  16, 
page  122. 


68  MEDICAL    HISTORY. 

York,  yet  they  will  apply  with  sufficient  correctness 
to  all  parts  of  the  Union.*  As  we  have  seen,  only 
three  or  four  states  had  attempted  to  place  any 
positive  restrictions  on  irregular  or  empirical 
practice ;  and  not  more  than  300  students  were 
annually  found  in  attendance  on  the  three  or  four 
medical  colleges  that  were  in  active  operation 
during  this  period  ;  and  the  whole  number  of  gra- 
duates did  not  average  fifteen  annually.  Still  this 
was  an  important  era  in  the.  history  of  American 
medicine.  It  was  the  period  of  emancipation,  if 
we  may  so  speak,  from  obedience  to  European 
theories,  and  dependence  on  European  institu- 
tions. It  was  the  forming  period  of  a  most  diffi- 
cult profession  in  a  new  and  widely  extended 
country,  and  while  the  great  mass  were  neither 
learned  in  science  nor  skilled  in  practice,  there 
were  to  be  found  in  every  state  a  few  who  had 
attained  pre-eminence  in  both. 

The  names  of  John  Warren,  Benj.  Waterhouse, 
Richard  Bayley,  Samuel  Bard,  Edward  Miller, 
Samuel  L.  Mitchell,  Wright  Post,  Nicholas 


*  The  folio-wing  preamble  to  a  law  passed  in  1786,  will  show 
something  in  regard  to  the  state  of  medicine  in  Virginia: — 

"  "Whereas,  the  practice  of  physic  in  this  colony  is  most  com- 
monly taken  up  and  followed  by  surgeons,  apothecaries,  or  such 
as  have  only  served  apprenticeships  to  tho?e  trades,  who  often 
prove  very  unskillful  in  the  art  of  a  physician,"  &c. — [See  Her- 
ring's Statutes  of  Virginia,  Vol.  4th. 


MEDICAL    HISTORY.  69 

Romaine,  Peter  Middleton,  John  Jones,  Benj. 
Rush,  Benj.  S.  Barton,  William  Shippen,  W.  P. 
Dewees,  John  Mitchell,  Lionel  Chalmers,  J.  Moul- 
trie,  and  several  others,  will  ever  constitute  a 
bright  galaxy  on  the  pages  of  American  medical 
history.  Many  of  these  were  not  only  learned, 
but  they  were  characterized  by  a  bold,  free  spirit 
of  inquiry,  which  soon  broke  through  the  theoreti- 
cal dogmas  of  that  day,  and  did  more  by  their 
writings  to  overthrow  the  absurdities  of  the  Boer- 
haavian  school  than  any  equal  number  of  their 
contemporaries  on  the  other  side  of  the  Atlantic. 
In  regard  to  the  medical  theories  or  opinions  that 
prevailed  at  the  period  which  closes  this  chapter, 
we  are  told  by  Dr.  Rush  that  "  the  system  of 
Boerhaave  long  ago  ceased  to  regulate  the  prac- 
tice of  physic.  It  was  succeeded  by  the  system 
of  Cullen.  In  the  year  1790,  Dr.  Brown's  system 
of  medicine  was  introduced  and  taught  by  Dr. 
Gibbon.  It  captivated  a  few  young  men  for  a 
while,  but  it  soon  fell  into  disrepute."  In  the  year 
1790,  Dr.  Rush  promulgated  some  principles  which 
he  regarded  as  the  foundation  of  a  new  system  in 
medicine,  of  which  the  f  Rowing  is  a  summary  in 
his  own  language : — "  This  system  rejects  the 
nosological  arrangement  of  diseases,  and  admits 
only  of  a  single  disease,  consisting  in  different 
forms  of  morbid  excitement,  induced  by  irritants 


70  MEDICAL    HISTORY, 

acting  upon  previous  debility.  It  rejects,  further, 
an  undue  reliance  upon  the  powers  of  nature,  and 
teaches  instantly  to  rest  the  cure  of  all  violent  and 
feeble  diseases  out  of  her  hands ;  and  lastly;  it  re- 
jects prescriptions  for  the  names  of  diseases ;  and 
by  directing  their  application  wholly  to  their  form- 
ing and  fluctuating  states,  derives  from  a  few  ac- 
tive medicines  all  the  advantages  which  have  been 
in  vain  expected  from  the  numerous  articles  which 
compose  European  treatises  upon  the  materia 
medica."  But  notwithstanding  the  plausability 
of  the  doctrines  promulgated  by  Dr.  Rush,  the 
system  of  Cullen  still  held  sway  in  the  minds 
of  the  majority  of  practitioners  throughout  the 
country.  He,  however,  struck  an  effectual  blow 
against  those  cumbersome  and  arbitrary  nosolo- 
gical  arrangements  which  had  so  long  served  to 
mislead  and  obscure,  rather  than  enlighten,  the 
professional  mind.  These  doctrines  were  also 
chiefly  instrumental  in  causing  the  general  adop- 
tion, in  this  country,  of  a  much  more  active  and 
depletory,  or  antiphlogistic,  system  of  treating 
diseases  than  had  previously  prevailed— a  system 
of  treatment,  indeed,  which  still  retains  the  confi- 
dence of  a  large  portion  of  the  profession.  Jt  is 
true  that  his  opinions  and  recommendations  in 
regard  to  blood-letting,  were  sometimes  extrava- 
gant, and,  on  that  account,  have  more  recently 


MEDICAL    HISTORY.  71 

met  with  severe  censure  from  the  most  eminent 
members  of  the  profession.*  But  before  we  in- 
dulge in  a  too  sweeping  condemnation,  and  attri- 
bute to  Dr.  Rush  the  origin  of  all  the  evils  which 
have  resulted  from  a  too  prodigal  indulgence  in 
the  use  of  the  lancet,  we  should  first  inquire  into 
the  particular  character  of  the  diseases  prevalent 
in  the  community  during  the  period  of  his  own 
observations ;  second,  whether  that  character  has 
since  undergone  any  change ;  and  third,  whether 
the  evils  alluded  to  were  owing  to  his  erroneous 
doctrines,  or  to  the  application  of  them,  unchanged 
by  his  successors  to  diseases  essentially  modified 
in  their  character.  If  we  call  to  mind  the  habits 
of  the  people  of  Philadelphia  just  previous  to  the 
Revolutionary  war,  as  already  briefly  detailed  in 
the  preceding  chapter,  and  remember  that  upon 
such  habits  supervened  the  strong  and  universal 
political  and  warlike  excitement  of  the  Revolution 
itself,  accompanied  by  far  greater  abstemiousness 
and  physical  hardihood,  we  shall  not  fail  to  see  a 
combination  of  causes  well  calculated  to  give  a 
highly  stenic  or  inflammatory  character  to  all 
such  diseases  as  should  prevail  at  that  period. 
Neither  did  the  influence  of  these  causes  cease 
for  several  years  after  the  close  of  the  war.  But 


*  See  Beck  on  Blood-letting  in  the  Young  Subject. 


MEDICAL    H1STOBV. 


we  are  not  left  simply  to  inferences  in  regard  to 
the  nature  of  the  diseases  of  that  period.  Dr. 
Rush  says,  in  speaking  of  the  diseases  of  Phila- 
delphia :  "  Fevers  have  assumed  several  new 
forms  since  the  year  1766,  The  mild  bilious  fever 
has  gradually  extended  itself  over  the  whole  city. 
*  *  *  In  the  years  1791  and  1792,  it  assumed 
an  inflammatory  appearance,  and  was  accompa- 
nied, ia  many  cases,  with  hepatic  affections.  It 
appeared  in  1793  as  an  epidemic,  in  the  fofm  of 
what  is  called  yellow  fever,  in  which  form  it  has 
appeared,  in  sporadic  cases,  or  as  an  epidemic, 
nearly  every  year  since.  During  the  reign  of 
this  high  grade  of  bilious  fever,  mild  intermittents, 
and  remittents,  and  the  chronic  or  nervous  forms 
of  the  summer  and  autumnal  fever,  have  nearly  dis- 
appeared. Inflammations  and  obstructions  of  the 
liver  have  been  more  frequent  than  in  former  years, 
and  even  the  pneumonias,  catarrhs,  intercurrent, 
and  other  fevers  of  the  winter  and  spring  months, 
have  all  partaken  more  or  less  of  the  inflamma- 
tory and  malignant  nature  of  the  yellow  fever." 
Whoever  will  compare  the  most  accurate  accounts 
which  are  left  on  record,  of  the  diseases  that  pre- 
vailed between  1780  and  1806,  with  the  pheno- 
mena of  diseases  prevalent  in  the  same  cities  at 
the  present  time,  will  certainly  find  little  difficulty 
in  recognising  a  marked  difference  in  their 


MEDICAL    HISTORY.  73 

character.  How  much  similarity  is  there  be 
tween  the  slow  nervous  or  typhoid  fevers,  which 
occur  in  all  our  large  cities,  or  the  more  fully 
formed  typhus  of  the  emigrants  and  poorer 
classes,  and  the  congestive,  inflammatory,  and 
rapidly  progressing  fevers  of  the  period  embraced 
in  this  chapter  of  our  history?  and  what  right 
have  we  to  judge  of  the  propriety  of  active  de- 
pletion in  the  latter  by  our  knowledge  of  its 
effects  in  the  former?  No  more,  certainly,  to  use 
an  apt  comparison  of  Rush,  than  we  have  to 
consult  the  almanacs  of  1803  for  the  monthly 
phases  of  the  moon  of  the  present  year. 

The  character  of  diseases,  however,  not 
only  varies  at  different  periods  of  time,  but  in 
different  localities  also.  Thus,  I  have  been  inti- 
mately acquainted  with  the  practice  of  a  phy- 
sician, who,  during  a  ten  years'  residence  and 
extensive  practice  in  a  rugged  agricultural  dis- 
trict, was  uniformly  in  the  habit  of  using  the 
lancet  freely  in  the  first  stage  of  all  febrile  and 
inflammatory  attacks  occurring  in  his  district, 
where  the  patient  had  been  previously  in  good 
health,  and  with  the  most  decided  and  uniform 
success.  But  does  any  one  imagine  that  the 
same  results  would  follow  the  application  of  this 
practice  among  the  delicate  and  fashionable 
classes  on  the  one  hand,  or  the  ill-fed  and 

4 


74  MEDICAL    HISTORY. 

uncared  for  poor  on  the  other,  which,  together, 
make  up  so  large  a  share  of  the  population  of  all 
our  large  cities  ?  The  truth  is,  that  professional 
men  are  too  apt,  though  perhaps  unconsciously, 
to  think  and  speak  of  disease  as  a  positive  entity 
— as  a  something  with  well  defined  and  uniform 
characteristics ;  and  hence  they  are  continually 
prone  to  condemn  their  predecessors  for  using,  in 
a  given  disease,  whatever  their  own  experience 
shows  to  be  inapplicable  to  the  disease,  called  by 
the  same  name,  as  it  occurs  in  their  day.  A  full 
recognition  of  the  fact,  that  disease  is  only  a 
morbid  condition  of  previously  healthy  functions 
or  structures,  would  show  every  thinking  mind 
that  the  special  tone  or  character  of  any  disease 
must  depend  entirely  on  the  tone  or  character  of 
the  previous  standard  of  health  and  the  quality 
of  the  exciting  causes.  Every  intelligent  phy- 
sician fully  recognizes  this  principle  in  its  appli- 
cation to  different  cases  of  the  same  disease 
occurring  in  his  own  practice  ;  but  often  forgets 
it  when  comparing  his  practice  with  that  of  his 
predecessors,  or  even  with  that  of  his  cotem- 
poraries  of  a  distant  and,  perhaps,  essentially  dif- 
ferent locality; — hence,  he  is  apt  to  condemn 
others  for  what  is  really  his  own  fault,  viz. :  an 
attempt  to  apply  the  practice  of  another  to  a 
disease,  merely  because  it  is  called  by  the  same 


•  MEDICAL    HISTORY.  75 

name,  without  reference  to  the  question  whether 
it  prevails  in  a  similar  locality,  among  people  of 
the  same  habits,  and  arising  from  causes  of  the 
same  quality  and  grade  of  intensity.  If  we  feel 
the  force  of  these  thoughts,  while  we  remember 
that  Dr.  Rush  came  upon  the  stage  of  action 
at  a  period  when  the  professional  mind  had 
scarcely  yet  divested  itself  of  the  humoral  and 
expectant  notions  of  treatment  inculcated  by  the 
Bosrhaavian  school,  and  that  he  lived  in  the  midst 
of  opposition,  we  shall  feel  much  more  disposed 
to  excuse  than  censure  his  seeming  extrava- 
gancies, and  to  enquire  seriously  whether  we  have 
as  rigidly  examined  the  diseases  of  our  day,  as 
he  did  those  of  his. 

The  views  of  Dr.  Rush,  in  reference  to  bleed- 
ing, were  warmly  seconded  by  Drs.  Griffitts, 
Dewees,  Physick,  etc.,  while  they  were  stren- 
uously opposed  by  many  others.  In  1806,  Dr. 
W.  P.  Dewees  published  his  elaborate  and  inte- 
resting Inaugural  Thesis,  "on  the  means  of  mode- 
rating or  relieving  pain  during  the  process  of 
Parturition."  In  this  paper,  he  maintained  the 
doctrine,  that  "pain  was  an  accidental  or  mor- 
bid symptom  of  labor — the  result  of  artificial 
modes  of  living  and  treatment."  The  remedy 
which  he  proposed,  and  successfully  practiced 
through  a  long  series  of  years,  was  copious 


76  MEDICAL    HISTORY. 

blood-letting.  The  same  doctrines  and  practices 
had  been  ably  defended  by  Dr.  Peter  Miller,  in 
an  Inaugural  Thesis,  published  in  Philadelphia  in 
1804  ;  but  Miller  had  himself  attended  the  private 
lectures  of  Dr.  Dewees,  and  doubtless  derived 
from  him  the  views  set  forth  in  his  essay.  The 
views  of  Dr.  Dewees  on  this  subject  met  the  cor- 
dial approbation  of  both  Rush  and  Shippen  ;  the 
latter  of  whom  is  said  to  have  declared  that  the 
Thesis  of  1806  "marked  an  era  in  the  history  of 
medicine."  It  is  true  that  bleeding  during  partu- 
rition had  long  been  practiced  in  different  coun- 
tries of  Europe,  and  even  by  the  midwives  of 
Genoa ;  but  its  advocacy  for  the  purposes  men- 
tioned in  the  paper  of  Dewees,  and  to  the  copious 
extent  practiced  by  him  and  his  followers,  was 
new,  and,  therefore,  strictly  American  in  its  ori- 
gin. The  reader  will  not  fail  to  notice,  that  the 
doctrine  here  advocated  in  reference  to  the  nature 
of  the  pains  of  labor,  is  directly  the  opposite  of 
that  inculcated  by  a  distinguished  professor  and 
author  in  the  same  city,  now  occupying  the  front 
rank  among  the  obstetricians  of  the  present  age. 
Neither  will  he  fail  to  notice  that  Dewees  prac- 
ticed copious  bleeding  for  the  same  purpose,  and, 
in  many  instances,  enforced  its  necessity  with 
the  same  arguments  that  are  now  used  by  Simp- 
son and  others  in  favor  of  anesthetic  agents. 


MEDICAL    HISTORY.  77 

The  following  paragraph  from  Rush's  celebrated 
defence  of  blood-letting  is  worthy  of  notice,  as 
showing  that  the  very  idea — the  practical  accom- 
plishment of  which  constitutes  one  of  the  promi- 
nent glories  of  medicine  in  our  day — was  fully 
present  in  the  minds  of  such  men  as  Rush  and 
Dewees : — 

"  I  have  expressed  a  hope  in  another  place,"* 
says  Dr.  Rush,  "that  a  medicine  would  be  dis- 
covered that  should  suspend  sensibility  altogether, 
and  leave  irritability  or  the  powers  of  motion  un- 
impaired, and  thereby  destroy  labor  pains  altoge- 
ther. I  was  encouraged  to  cherish  this  hope  by 
having  known  delivery  to  take  place  in  one  in- 
stance, during  a  paroxyism  of  epilepsy  ;  and  hav- 
ing heard  of  another,  during  a  fit  of  drunkenness, 
in  a  woman  attended  by  Dr.  Church,  in  both  of 
which  there  was  neither  consciousness  nor  recol- 
lection of  pain."  Here  the  drunken  woman, 
doubtless,  presented  as  fair  a  case  of  anaesthesia 
as  though  she  had  inhaled  ether  or  chloroform. 
Dr.  Rush  even  goes  further  than  Dewees,  and 
represents  the  uterus  as  in  a  diseased  state  during 
the  period  of  pregnancy  and  parturition.  He  says, 
"  In  pregnancy,  the  uterus  is  always  affected  with 
that  grade  of  morbid  action  which  I  formerly 


*  See  Medical  Repository,  V<-1.  YI, 


78  MEDICAL    HISTORY. 

called  inflammation.  This  is  evident  from  its  ex- 
hibiting all  its  usual  phenomena  in  other  parts  of 
the  body."  Again,  he  says, 

"  Parturition  is  a  higher  grade  of  disease  than 
that  which  takes  place  in  pregnancy.  It  consists 
of  convulsive  or  chronic  spasms  in  the  uterus, 
supervening  its  inflammation,  and  is  accompanied 
with  chills,  heat,  a  quick,  full,  tense,  or  a  frequent 
and  depressed  pulse,  and  great  pain."  And  after 
alluding  to  one  of  the  most  important  points  dis- 
cussed in  the  well-known  correspondence  between 
Professors  Meigs  and  Simpson,  relative  to  the 
propriety  of  obviating  the  pains  of  labor  by  the 
use  of  anaesthetic  agents,  he  adds,  "  I  was  induced 
to  believe  that  pain  does  not  accompany  child- 
bearing  by  an  immutable  decree  of  Heaven." 
Hence,  he  fully  accords  with  Dr.  Dewees  in 
recommending  free  and  even  copious  blood-letting 
to  relieve  the  pains  of  pregnancy  and  parturition, 
unless  it  should  be  contra-indicated  by  previous 
inanition  or  other  causes  of  langour  and  enfeebled 
circulation. 

Perhaps  no  one  thing  has  served  to  render  the 
period  now  under  consideration  more  conspicuous 
than  the  warm  and  interesting  controversy  which 
was  maintained  in  reference  to  contagion,  espe- 
cially as  applied  to  the  origin  and  spread  of  yellow 
fever/  The  repeated  visitations  of  this  disease, 


MEDICAL    HISTORY.  79 

even  as  far  north  as  New  York  and  Philadelphia, 
during  the  last  part  of  the  eighteenth  and  the  first 
few  years  of  the  nineteenth  centuries,  caused  it  to 
be  a  subject  of  absorbing  interest.  And  as  it  was 
always  confined  to  commercial  towns  and  cities 
located  near  the  sea,  or  the  Islands  in  the  Indies, 
it  was  very  natural  that  the  earliest  observers 
should  attribute  it  to  importation,  and  regard  it, 
therefore,  as  a  highly  contagious  disease.  The 
correctness  of  this  view  was  soon  called  in  ques- 
tion, however;  and,  though  supported  by  such 
men  as  Lining  of  South  Carolina,  Mitchell  of 
Virginia,  and  Hosack  of  New  York,  yet  it  rapidly 
lost  its  hold  on  the  professional  mind  of  this  coun- 
try, under  the  most  searching  and  able  opposition 
of  Dr.  Rush  and  a  few  others.  And  few  questions 
are  considered  better  settled  at  the  present  day 
than  that  yellow  fever  is  not  contagious.  Those 
who  desire  to  examine  this  interesting  subject 
with  care,  will  do  well  to  consult  the  early 
volumes  of  the  Neio  York  Medical  Repository, 
the  two  medical  journals  then  published  in  Phila- 
delphia, and  also  the  Medical  Inquiries  and  Ob- 
servations of  Dr.  Rush.  Before  closing  this 
chapter,  we  must  allude  to  two  important  histori- 
cal mistakes  made  by  eminent  medical  men 
abroad.  The  first  is  by  Dr.  John  Armstrong, 
who  attributes  to  Dr.  Robert  Hamilton  the  merit 


80  MEDICAL    HISTORY. 

of  first  introducing  the  use  of  mercury  as  a  remedy 
in  inflammatory  diseases.  The  latter  gentleman, 
in  his  own  account  of  the  remedy,  says  his  atten- 
tion was  first  called  to  it  by  a  medical  officer  of 
the  army,  in  1764 ;  whereas,  we  have  seen  in  the 
preceding  chapter,  what  Dr.  J.  B.  Beck  has  so 
fully  presented  in  his  little  volume  on  Infant 
Therapeutics,  that  mercury,  in  the  form  of  calo- 
mel was  used  in  a  malignant  epidemic  sore  throat 
by  Dr.  Douglass  of  Boston,  as  early  as  1736.  It 
was  still  more  extensively  used  and  recommended 
by  Dr.  James  Ogden  of  Long  Island,  in  1749; 
and  it  was  very  successfully  introduced  into  the 
practice  of  the  pi'ofession  in  Philadelphia,  about 
the  same  time,  by  Dr.  Thomas  Bond.  And  Dr. 
Rush  says,  in  speaking  of  the  period  which  inter- 
vened between  1760-66,  "  Mercury  was  in  general 
use  in  the  years  that  have  been  mentioned."  We 
thus  see  that  the  practice  of  which  Dr.  Armstrong 
speaks,  was  already  in  general  use  in  the  Ameri- 
can colonies,  even  prior  to  the  time  it  was  first 
suggested  to  Dr.  Hamilton.  The  second  mistake 
to  which  we  allude  is  that  of  Dr.  Stokes,  in  his 
valuable  treatise  on  diseases  of  the  chest,  where 
he  gives  Dr.  Cheyne  the  credit  of  having  first 
introduced  the  practice  of  giving  tartar-emetic  in 
the  cynanche  trachialis  or  croup.  The  first  pub- 
lication on  the  subject  by  Dr.  Cheyne  was  in 


MEDICAL    HISTORY.  81 

1801.  But  Dr.  Richard  Bayley  of  New  York 
had  accurately  pointed  out  the  great  value  of  this 
remedy  in  the  same  disease,  in  a  letter  to  Dr.  Wm. 
Hunter,  published  in  New  York  city  in  1781,  just 
twenty  years  previous  to  the  publication  of  Dr. 
Cheyne.  Dr.  Bayley  is,  not  only  fully  entitled  to 
the  credit  given  by  Dr.  Stokes  to  Dr.  Cheyne, 
but  it  is  to  him  that  the  profession  are  also  in- 
debted for  having  first  pointed  out  the  true  inflarn^ 
matory  nature  of  the  disease  here  referred  to.  It 
was  also  during  the  last  part  of  the  eighteenth 
century  that  Dr.  Thomas  Cadwallader,  of  Phila- 
delphia, first  introduced  the  practice  of  treating 
the  "  dry  gripes,"  or  colica  pictonum  and  bilious 
colic  with  anodynes,  until  the  pains  and  spasms 
were  allayed,  and  then  moving  the  bowels  only 
by  gentle  laxatives.  The  almost  universal  custom 
had  been  to  give  the  most  active  and  drastic  pur- 
gatives, which  often  served  only  to  increase  the 
muscular  contraction  of  the  intestines,  instead  of 
relieving  the  patient.  The  treatment  practiced 
by  Dr.  Cadwallader  was  afterwards  adopted  and 
highly  recommended  by  Dr.  Warren,  of  London. 
The  medical  writings  of  this  period  seem  to 
have  been  confined  almost  wholly  to  the  pages  of 
the  three  medical  journals  which  had  been  estab- 
lished in  New  York  and  Philadelphia,  and  to  here 
and  there  a  pamphlet  or  a  paper  read  before 

4* 


82  MEDICAL    HISTORY. 

organized  society.  Indeed,  I  have  not  been  able 
to  find  a  single  volume  on  any  branch  of  medical 
science  or  practice,  published  by  an  American 
physician  during  the  first  twenty  years  after  the 
close  of  the  Revolutionary  War. 

And  yet,  as  we  have  already  seen,  it  was  a 
period  in  our  history  which  was  graced  with  some 
of  the  noblest  and  most  active  minds  ever  devoted 
to  the  cultivation  of  medical  science.  But  the  art 
of  mere  book  making,  which  has  been  brought  to 
such  perfection  in  this,  bur  day,  was  little  known 
to  our  professional  ancestors. 


CHAPTER  III. 

HISTORY  OF  THE  PROGRESS  OF  MEDICAL  EDUCATION 
FROM  THE  YEAR  ONE  THOUSAND  EIGHT  HUNDRED 
AND  SIX  TO  ONE  THOUSAND  EIGHT  HUNDRED  AND 
FIFTY. 

To  those  who  limit  the  means  of  education  to 
the  preceptor's  office,  and  the  college  halls,  and 
the  period  of  its  acquirements  to  the  season  of 
pupilage  (and  there  are,  unfortunately,  many 
such),  much  of  the  matter  contained  in  this  work 
may  appear  irrevelant  or  superfluous.  But  it  is 
unnecessary  for  us  to  state  that  we  attach  to  the 
word  a  far  more  liberal  and  comprehensive  mean- 
ing. Whatever  increases  the  enterprize,  stimu- 
lates the  spirit  of  philosophical  investigation,  or 
adds  an  item  to  the  stock  of  knowledge  possessed 
by  the  profession,  or  whatever  elevates  it  in  the 
great  scale  of  social  being,  is  as  truly  a  part  of  its 
education  as  is  the  study  of  its  text-books,  and  the 
frequenting  of  its  schools.  The  latter  may,  in- 
deed, constitute  the  foundation,  but  many  other 


84  MEDICAL    HISTORY. 

things  are  required  to  complete  the  superstructure 
of  a  fair  medical  education.  And  among  those 
other  things,  none  are  jj^greater  importance  than 
well  organized  associations,  admitting  of  frequent 
communications,  and  free  interchange  of  thought 
among  their  members.  Such  associations  not 
only  elicit  observations,  stimulate  investigations, 
and  save  from  oblivion  numberless  facts,  but  they 
counteract  the  selfish  feelings  of  individuality — 
they  diffuse  knowledge — they  elevate  the  social 
feelings — and  they  embody  and  generalize  facts 
that  otherwise  would  remain  isolated  and  useless. 
In  this  respect,  the  commencement  of  the  period 
embraced  in  this  chapter,  forms  an  important  era 
in  the  history  of  the  medical  profession  in  this 
country.  For  though  several  medical  societies 
had  been  duly  incorporated,  and  some  of  them 
continued  in  active  operation  for  a  quarter  of  a 
century,  yet  they  were  almost  wholly  confined  in 
their  influence  to  a  few  of  the  larger  cities. 
Hence,  as  intimated  near  the  close  of  the  last 
chapter,  the  great  mass  of  the  profession  were 
alike  unsocial  and  ungoverned  by  ethical  laws,  and, 
consequently,  without  harmony  of  action  or  true 
dignity  of  professional  character.  This  condition 
of  things  was  fully  appreciated  by  a  few  enlight- 
ened members  of  the  profession  in  Saratoga 
County,  New  York,  so  early  as  1796;  durinn- 


MEDICAL    HISTORY.  85 

which  year  several  articles  on  the  subject  of  a 
local  medical  association  appeared  in  the  news- 
papers of  that  county.  These  articles,  we  be- 
lieve, were  from  the  pen  of  Dr.  John  Stearns, 
then  residing  in  that  section  of  the  state.  So 
much  attention  was  awakened,  that  a  county  so- 
ciety was  soon  after  formed,  containing  twenty- 
one  members  ;  but  so  discordant  were  their  feel- 
ings and  modes  of  thought,  that  the  same  year 
saw  both  its  organization  and  dissolution.  This 
failure,  however,  by  no  means  deterred  the  en- 
lightened advocates  of  medical  organization  from 
further  efforts.  In  November,  1805,  another 
meeting  of  the  physicians  of  Saratoga  County  was 
held,  and  a  resolution  adopted,  inviting  their  me- 
dical brethren  in  Washington  and  Montgomery 
bounties  to  join  them  in  the  formation  of  a  so- 
ciety, to  be  incorporated  by  the  state  legislature. 
The  committee  appointed  to  carry  the  resolution 
into  effect,  consisted  of  Drs.  John  Stearns,  Wru. 
Patrick,  and  Grant  Powell.  The  committee 
issued  a  circular  to  the  physicians  of  Washington 
and  Montgomery,  in  response  to  which,  they  sent 
delegates  to  the  adjourned  meeting  at  Ballston, 
on  the  16th  of  January,  1806.  A  memorial  to  the 
legislature,  asking  for  an  act  of  incorporation,  was 
reported  at  this  meeting,  adopted,  and  a  committee 
appointed  to  carry  it  into  effect.  This  committee 


86  MEDICAL    HISTORY. 

consisted  of  Dr.  John  Stearns,  of  Saratoga, 
Dr.  Alex.  Sheldon,  of  Montgomery,  and  Dr.  Asa 
Fitch,  of  Washington.  Fortunately  the  two  first 
members  of  the  committee  had  been  also  elected 
members  of  the  popular  branch  of  the  legislature, 
and  one  of  them,  Dr.  Shelden,  was  elected  speaker 
of  the  house. 

It  will  be  observed  that  the  memorial  contem- 
plated nothing  more  than  the  passage  of'  a  law  in 
reference  to  the  three  counties  named ;  but  the 
enlightened  committee,  to  whom  it  had  been  com- 
mitted, in  presenting  it  to  the  legislature,  took  a 
wider  survey  of  the  wants  of  the  profession,  and 
asked  for  a  law  applicable  to  every  county  in  the 
state.  The  memorial  to  the  House  of  Assembly 
was  referred  to  a  committee  of  five,  a  majority  of 
whom  were  medical  men ;  and  they,  consequently, 
soon  matured  and  reported  a  general  act  of  in- 
corporation, not  only  applicable  to  each  county 
in  the  state,  but  also  providing  for  a  state  society, 
composed  of  delegates  from  the  several  county 
associations.  But  politicians  so  magnified  the 
dangers  to  which  the  state  would  be  exposed  from 
the  incorporation  of  more  than  forty  associations 
of  physicians  within  its  limits,  that,  despite  of  the 
most  earnest  support  of  both  committees,  the  re- 
jection of  the  proposed  law,  by  a  large  majority, 
was  considered  almost  certain.  Owing,  however, 


MEDICAL    HISTORY.  87 

to  the  very  able  and  eloquent  advocacy  of  the  bill, 
at  this  critical  period,  by  the  Hon.  Wm.  W.  Van 
Ness,  it  finally  received  the  sanction  of  the  legis- 
lature on  the  4th  of  April,  1806. 
•_.  This  law  authorized  the  legally  qualified  physi- 
cians and  surgeons  of  each  county  to  form  them- 
selves into  a  society,  named  after  the  county  in 
which  it  was  formed,  with  power  to  choose  offi- 
cers, make  all  needful  rules  for  the  government 
of  its  members,  and  appoint  a  board  of  censors  to 
examine  and  license  all  the  applicants  for  admis- 
sion into  the  profession  in  their  respective  coun- 
ties. But  no  one  could  be  admitted  to  an  exam- 
ination until  he  had  given  evidence  of  having 
studied  three  years  with  some  practitioner,  and 
had  arrived  to  the  age  of  twenty-one  years.  A 
state  medical  society  was  also  provided  for,  to  be 
composed  of  one  delegate  from  each  county  so- 
ciety, and  such  permanent  members  as  the  society 
should  from  time  to  time  elect,  not  exceeding  two 
in  any  one  year.  It  was  required  to  meet  annu- 
ally at  the  capitol,  in  the  city  of  Albany,  to  elect 
officers,  and  transact  such  other  business  as  the 
interests  of  the  profession  should  require.  It  was 
also  required  to  divide  the  state  into  four  medical 
districts,  and  appoint  a  board  of  censors  for  each, 
whose  duty  it  was  to  examine  all  candidates  for 
license  to  practice  medicine  and  surgery,  who 


88  MEDICAL    HISTORY. 

should  present  themselves,  after  having  studied 
the  required  length  of  time.  The  law  also  forbid 
any  to  enter  the  profession,  and  collect  pay  for 
their  services,  without  first  procuring  either  a  li- 
cense from  a  county  or  state  society,  or  a  diploma 
from  some  regularly  organized  medical  college. 
Candidates  who  might  be  rejected  by  the  county 
boards  had  the  right  to  appeal  to  the  censors  of 
the  state  society  for  another  examination ;  but 
not  vice  versa. 

Within  two  years  after  the  passage  of  this  law, 
nearly  every  county  in  the  state  had  its  regularly 
organized  medical  society,  with  its  board  of  cen- 
sors and  library. 

The  first  meeting  of  the  state  society  was  held 
at  the  capital  in  February,  1807,  and  completed 
its  organization,  according  to  the  provisions  of 
the  law.  Thus  two  great  and  all  important  ob- 
jects were  accomplished,  viz. :  a  thorough  organ- 
ization of  the  profession  in  a  manner  most  favor- 
able to  its  advancement  and  elevation,  and  the 
provision  for  having  all  candidates  examined  be- 
fore admission,  by  practitioners  themselves,  with- 
out the  intervention  of  any  other  class.  In  the 
following  year,  1807,  an  act  was  passed,  making 
some  further  provisions  for  the  internal  organiza- 
tion of  the  state  society,  and  also  prescribing  a 
penalty  of  five  dollars  per  month  for  practicing 


MEU16AL    HISTORY. 

without  being  authorized  according  to  the  act 
of  the  previous  year.  This  penalty,  however, 
was  not  to  apply  to  persons  using,  for  the  benefit 
of  the  sick,  any  roots  or  herbs,  the  growth  of  the 
United  States.  In  May,  1812,  the  legislature  in- 
creased the  foregoing  penalty  to  twenty-five  dol- 
lars for  each  offense,  and  required  that  all  licenses 
in  future  should  be  deposited  in  the  county  clerk's 
office.  In  1813,  these  several  acts  were  revised 
and  consolidated  into  one  statute,  and  continued 
without  alteration  until  1818,  when  the  legislature 
passed  an  act  increasing  the  term  of  study  to  four 
years ;  but  one  year  might  be  deducted  if  the  stu- 
dent had  pursued  classical  studies  that  length  of 
time,  after  the  age  of  sixteen  years,  or  had  at- 
tended a  complete  course  of  lectures,  delivered  by 
each  of  the  professors  on  all  the  branches  of  medi- 
cal sciencs  in  the  medical  colleges  of  this  state, 
or  elsewhere. 

In  the  following  year,  another  act  was  passed, 
prohibiting  the  medical  colleges  from  granting  the 
degree  of  Doctor  of  Medicine  to  any  student  who- 
had  not  fully  complied  with  the  requisitions  of  the 
act  of  1818.  The  next  law  of  importance  enacted 
in  this  state  was  that  passed  by  the  legislature  in 
1827.  This  leaves  the  term  of  study,  and  the 
conditions  for  obtaining  a  license  to  practice,  es- 
sentiallv  the  same  as  before  ;  but  the  12th  section 


90  MEDICAL    HISTORY. 

provided  that  "  no  person  shall  receive  from  the 
regents  of  the  university  a  diploma  conferring  the 
degree  of  Doctor  of  Medicine,  unless  he  shall  have 
pursued  the  study  of  medical  science  for  at  least 
three  years,  after  the  age  of  sixteen,  with  some 
physician  or  surgeon  duly  authorized  by  law  to 
practice  his  profession,  and  shall  also  have  at- 
tended two  complete  courses  of  all  the  lectures 
delivered  in  an  incorporated  medical  college,  and 
have  attended  the  last  of  such  courses  in  the  col- 
lege, by  which  he  shall  be  recommended  for  his 
degree."  And  section  20th  declares,  that  no  per- 
son under  the  age  of  twenty-one  years  can  be  en- 
titled to  practice  physic  and  surgery  in  this  state. 
Another  provision  of  this  law  required  all  regu- 
larly licensed  physicians  to  file  a  copy  of  their 
license  or  diploma  in  the  county  clerk's  office,  and 
become  members  of  the  county  society  in  the 
county  of  their  residence,  before  they  were  legally 
entitled  to  collect  pay  for  their  services. 

Such  are  the  essential  features  of  the  legislative 
enactments,  adopted  from  time  to  time  for  the  in- 
ternal organization  and  regulation  of  the  medical 
profession  in  the  state  of  New  York  ;  and 
though  exceedingly  defective  in  many  respects, 
they  exerted  a  decided  and  beneficial  influence 
over  the  great  mass  of  the  profession.  The  fre- 
quent contact  with  each  other,  and  the  mutual 


MEDICAL    HISTORY.  91 

interchange  of  sentiments,  which  took  place  in 
the  county  societies,  soon  led  the  practitioners  to 
a  more  thorough  knowledge  of  each  other,  and, 
consequently,  to  the  adoption  of  by-laws  and  sound 
rules  of  ethics  for  their  mutual  government.  This 
again  led  to  a  far  more  .dignified  and  -honorable 
intercourse  with  each  other  in  private  practice. 
The  meetings  of  these  societies  were  occupied  in 
the  reading  of  essays,  the  relation  of  cases,  and 
the  discussion  of  topics  connected  with  medical 
practice,  and  generally  with  the  diseases  of  their 
own  counties  ;  and  not  a  few  of  the  papers  read 
at  their  meetings  would  do  credit  to  any  learned 
body.  The  presidents  of  the  societies  were  also 
generally  required  to  deliver  an  address  at  each 
anniversary  meeting.  Some  of  these  were  pub- 
lished either  in  pamphlet  form  or  in  the  medical 
journals — some  found  their  way  into  the  transac- 
tions of  the  state  society,  and  all  were  not  only 
interesting,  but  well  calculated  to  excite  a  spirit 
of  investigation,  and  divert  the  attention  of  prac- 
titioners from  the  petty  jealousies  of  private  com- 
petition to  the  study  of  medicine  as  a  science. 

In  the  early  part  of  this  period,  the  number  of 
medical  colleges  in  the  Union  were  but  few,  and 
the  degrees  conferred  by  them  much  less  sought 
after  than  at  present ;  and  hence  many  of  the  candi- 
dates for  admission  into  the  ranks  of  the  profession 


92  MEDICAL    HISTORY. 

were  examined  and  licensed  by  the  county  so- 
cieties, and  the  fees  derived  from  the  granting 
of  such  licenses  were  in  most  cases  devoted  to  the 
purchase  of  books  to  constitute  a  county  library.  By 
this  means  the  latest  and  best  medical  works  were 
constantly  being  brought  within  the  reach  of 
every  practitioner;  and  hence  these  libraries  be- 
came powerful  auxiliaries  in  the  general  diffusion 
of  medical  knowledge.  The  same  ends  were  still 
further  promoted  by  the  action  of  the  state  so- 
ciety, which  was  organized  February  3d,  1807.* 
Thus  we  find  the  society  at  its  first  meeting  di- 
recting each  member  "  to  present  a  geological 
and  topographical  description  of  the  county  in 
which  he  might  practice,  and  also  a  history  of 
such  diseases  as  might  prevail  in  his  particular 
place  of  residence,  etc."  Accordingly,  in  the 
following  year,  we  find  reports  in  compliance  with 
this  direction,  from  no  less  than  seven  members, 
viz. — Dr.  Alex.  Sheldon,  of  Montgomery ;  Dr. 
David  II.  Arnell,  of  Orange ;  Dr.  Wm.  Wheeler, 
of  Dutchess  ;  Dr.  John  Stearns,  of  Saratoga  ;  Dr. 
Hugh  Henderson,  of  Jefferson ;  Dr.  Horatio 
Powell,  of  Clinton,  and  Dr.  Lyman  Cook,  of  West- 
chester.  At  this  second  annual  meeting  (Feb., 


*  For  a  brief  history  of  this  society,  including  the  names  of 
its  officers  from  year  to  year,  see  the  United  Slates  Medical  and 
Surgical  Journal,  vol.  ii. ;  and  also  the  published  transactions. 


MEDICAh    HISTORY.  93 

1808),  the  society  presented  to  the  profession  still 
stronger  inducements  to  engage  in  medical  inves- 
tigations, by  offering  three  premiums,  viz.  : — a 
medal  of  the  value  of  fifty  dollars  for  the  "  best 
dissertation  on  the  topography,  geology,  and 
mineralogv  of  any  countv  in  the  state,  together 

O*  •/  *" 

with  an  account  of  the  prevalent  diseases  in  said 
county."  Another  of  the  value  of  twenty-five 
dollars  for  the  second  best  dissertation  on  the 
same  subject ;  and  a  third  premium,  consisting  of 
a  medal  of  the  value  of  twenty-five  dollars,  for 
"  the  best  dissertation  on  the  causes,  and  best 
method  of  preventing  and  curing,  the  typhus 
mitior,  or  low  nervous  fever,  which  prevailed  in 
different  counties  of  the  state." 

These  offers  called  out  several  well  written 
essays,  and  the  first  premium  on  the  topography, 
etc.,  was  awarded  to  Dr.  John  Stearns,  of  Sara- 
toga County.  The  efforts  to  improve  medical 
science,  and  elevate  the  character  of  the  profes- 
sion, thus  early  and  actively  commenced,  have 
been  continued  with  unremitting  zeal  by  this  so- 
ciety until  the  present  time.  But  though  the  in- 
fluence of  the  state  and  county  societies  has  been 
highly  beneficial  to  the  profession,  yet  that  influ- 
ence has  been  in  some  measure  counteracted  by 
defects  in  the  laws,  and  other  circumstances,  over 
which  they  had  not  control.  Thus,  while  the 


94  MEDICAL    HISTORY. 

law  of  1812  increased  the  penalty  for  practicing 
without  a  license  or  diploma  to  twenty-five  dol- 
lars for  each  offense,  it  was  rendered  almost  en- 
tirely void  in  practice,  by  the  proviso,  "  that  it 
should  not  be  so  construed  as  to  prevent  any  person 
from  prescribing  for  the  benefit  of  the  sick,  any 
roots,  barks,  or  herbs,  the  growth  and  produce  of 
the  United  States." 

Although  the  design  of  this  provision  was,  un- 
doubtedly, simply  to  shield  nurses  in  their  com- 
mon practice  of  using  simple  domestic  teas  or  in- 
fusions, in  cases  of  sickness  not  considered  suffi- 
ciently severe  to  require  the  attendance  of  a  phy- 
sician, yet  in  practice  it  was  made  to  cover  every 
species  of  empiricism,  it  being  only  necessary  to 
plead  the  use  of  indigenous  remedies.  Hence,  al- 
though the  statutes  of  New  York  have  contained, 
apparently,  strict  prohibitory  or  protective  laws 
in  regard  to  medical  practice  for  more  than  thirty 
years,  those  laws  have  been  practically  inopera- 
tive from  their  own  defects,  and  cannot,  therefore, 
be  considered  as  any  test  of  the  practicability  or 
inpracticability  of  suppressing  quackery  by  penal 
enactments.  Another  important  defect  in  the 
laws  regulating  the  education  of  the  profession 
consisted  in  the  entire  omission  of  any  standard 
of  preliminary  education  as  a  requisite,  before 
commencing  the  study  of  medicine.  This  defect 


MKDICAL    HISTORY. 


not  only  existed  in  the  laws  regulating  the  pro- 
fession, but  equally  so  in  the  rules  adopted  by 
medical  societies  and  colleges  for  granting  the 
diploma  ;  hence  we  have  been,  and  still  are,  an- 
nually witnessing  the  ridiculous  spectacle  of  young 
men,  possessing  the  high  and  dignified  title  of 
Doctor  of  Medicine,  conferred  by  institutions 
called  colleges  and  universities,  who  are  destitute 
of  even  a  competent  knowledge  of  English  gram- 
mar. These  facts  sufficiently  explain  why,  not- 
withstanding the  existence  of  a  good  internal  or- 
ganization, and  the  united  efforts  of  state  and 
county  societies  during  a  period  of  forty  years, 
every  species  of  quackery  still  abounds  in  this  state 
—  they  show,  too,  that  the  repeal  of  that  part  of  the 
law  prescribing  a  penalty  of  twenty-five  dollars  for 
practicing  without  a  license  or  diploma  ;  and  also, 
that  which  renders  the  unlicensed  incompetent  to 
enforce  payment  for  their  services,  which  took 
place  in  J  843,  was  rather  the  repeal  of  an  obsolete 
form  than  the  removal  of  an  operative  law. 

The  medical  laws  of  New  Jersey  were  so 
amended  in  1816  as  to  prohibit  all  unlicensed 
persons,  who  were  not  already  engaged  in  prac- 
tice, from  entering  upon  those  duties  in  that  state, 
under  a  penalty  of  twenty-five  dollars  for  each 
offense.  Such  persons  were  also  disqualified  from 
collecting  any  compensation  for  medical  services. 


96  MEDICAL    HISTOUV. 

But,  instead  of  containing  the  neutralizing  proviso 
which  we  have  noticed  in  the  laws  of  New  York, 
it  declared  that,  "  this  act  shall  be  so  construed 
as  to  prevent  all  irregular  bred  pretenders  to  the 
healing  art,  under  the  names  or  titles  of  practical 
botanists,  root  or  Indian  doctors,  or  any  other 
name  or  title,  involving  quackery  of  any  .species, 
from  practicing  their  deceptions,  and  imposing  on 
the  ignorance  and  credulity  of  their  fellow-citi- 
zens." Some  unimportant  alterations  in  the 
medical  laws  of  this  state  were  made  by  the 
legislature  in  the  years  1818,  '23,  '25,  '30,  '38; 
but  their  main  features  still  remain  in  full  force. 
And  though  the  penal  provisions  against  unlicensed 
practitioners  are  very  seldom  enforced ;  yet  the 
influence  of  their  state,  and  district  or  county 
societies,  has  been  most  salutary  in  promoting 
friendly  intercourse,  stimulating  investigation, 
and  elevating  the  professional  character.  State 
and  district  medical  societies  were  organized  at 
an  early  period  in  all  the  New  England  States. 
We  have,  in  a  previous  chapter,  mentioned  the 
origin  of  those  in  Massachusetts,  Connecticut, 
and  New  Hampshire.  The  Maine  Medical  So- 
ciety was  incorporated  in  1821,  and  that  of  Rhode 
Island,  in  1812.  The  regulations  adopted  in  all 
these  states  were  very  similar.  They  all  required 
the  establishment  of  state  or  district  boards  of 


MEDICAL    HISTORY. 


'   97 


censors,  for  examining  and  licensing  candidates 
to  practice  ;  also  some  degree  of  preliminary  edu- 
cation, a  term  of  medical  study  not  less  than  three 
years,  and  the  attainment  of  the  age  of  twenty- 
one  years.  In  Massachusetts,  Rhode  Island,  and 
New  Hampshire,  the  boards  of  censors  were  un- 
connected with  the  medical  colleges  of  those 
states  ;  and  the  laws  required  all  persons  intend- 
ing to  commence  practice,  whether  educated  in 
those  states  or  already  licensed  by  the  institutions 
of  other  states,  to  apply  to  some  one  of  the  boards 
of  censors  for  a  license  before  they  were  authorized 
to  enforce  payment  for  their  services.  In  Con- 
necticut and  Maine,  but  one  board  of  censors  was 
established  in  each  state,  which  was  authorized 
to  examine  all  candidates,  whether  for  a  license 
or  the  higher  degree  of  M.D.  These  boards  are 
composed,  in  the  one  state,  of  the  medical  faculty 
of  Yale  College,  associated  with  an  equal  number 
of  censors  appointed  by  the  president  and  fellows 
of  the  Connecticut  Medical  Society,  the  president 
of  the  society  always  being  one  of  the  number : 
and  in  the  other,  of  the  Medical  Faculty  of  Bow- 
doin  College,  and  'an  equal  number  of  censors 
chosen  by  the  Maine  Medical  Society. 

In  January,  1822,  the  Medical  Society  of  the 
state  of  Delaware  was  authorized,  by  an  act  of 
the  legislature,  to  appoint  a  medical  board  of 


98     '  MEDICAL    HISTORY. 

examiners,  consisting  of  fifteen  members,  \vhose 
term  of  office  was  to  continue  five  years ;  and 
who  were  directed  to  examine  and  license  all 
candidates  for  admission  into  the  profession  in 
that  state.  The  requisites  for  admission  to  an 
examination  by  such  board  were,  three  years' 
study  with  some  respectable  practitioner,  the 
attendance  on  one  full  course  of  lectures  in  some 
medical  college,  and  the  attainment  of  twenty-one 
years  of  age.  But  graduates  of  respectable  medi- 
cal colleges  were  licensed  on  the  exhibition  of 
their  diplomas,  without  an  examination.  The 
same  penalties  were  enacted  against  unlicensed 
practitioners  as  in  the  state  of  Maryland.  The 
Medical  Society  of  the  district  of  Columbia  was 
incorporated  by  an  act  of  Congress  in  1819,  with 
power  to  appoint  a  board  of  examiners,  com- 
posed of  five  practitioners,  whose  duties  and  pri- 
vileges were  the  same  as  those  appointed  by  the 
Delaware  Medical  Society.  And  the  same 
penalty  was  enacted  against  unlicensed  and 
irregular  practitioners.  The  states  of  South 
Carolina,  Georgia,  Alabama,  Mississippi,  and 
and  Louisiana  have  all  had  laws  of  a  similar 
character,  for  thp  regulation  of  medical  education 
and  practice. 

In    1817,    the    legislature    of    South    Carolina 
enacted  a  law  establishing  two  medical  boards 


MEDICAL    HISTORY.  90 

of  examiners,  one  in  Charleston  and  the  other  in 
Columbia.  They  were  required  to  examine  all 
applicants  for  permission  to  practice  in  that  state, 
except  such  as  had  received  a  diploma  from  some 
medical  college,  and  grant  licenses  to  those  they 
deemed  qualified.  And  every  one  practicing 
without  such  license  was  liable  to  be  indicted  and 
fined  in  a  sum  not  exceeding  five  hundred  dollars, 
and  imprisoned  a  term  not  exceeding  two  months. 
These  regulations  continued  in  force  until  1838, 
when  all  restrictions  and  penalties  were  abolished 
by  an  act  of  the  state  legislature.  The  act  by 
which  a  fine  of  five  hundred  dollars  was  imposed 
on  all  who  should  practice  physic  in  Georgia 
without  a  license  from  the  board  of  physicians, 
was  passed  by  the  state  legislature  in  1826,  and 
continued  in  force  until  1835,  when  it  was 
repealed.  In  1839,  the  examining  board  of  phy- 
sicians was  re-organized,  and  again  invested  with 
power  to  examine  applicants  and  grant  licenses ; 
but  with  the  following  proviso,  which  nullifies  the 
whole  act,  viz.: — "  Provided  nothing  in  the  said 
revised  act  be  so  construed  as  to  operate  against 
the  Thompsonian  or  Botanic  practice,  or  any 
other  practitioner  of  medicine  in  this  state."  It 
should  also  be  mentioned  that  the  Thompsonians 
have  had  for  several  years  a  regularly  incorpo- 
rated college  in  that  state,  with  all  the  usual 


100  MEDICAL    HISTORY. 

collegiate  powers ;   but   at  present   its  existence 
appears  to  be  merely  nominal. 

In  Alabama,  an  act  was  passed  in  Dec.,  1823, 
requiring  the  establishment  of  five  boards  of 
medical  examiners  in  the  state,  each  consisting 
of  three  members,  elected  by  a  joint  vote  of  both 
houses  of  the  state  legislature.  Their  powers 
and  duties  in  regard  to  examining  and  licensing 
candidates  were  the  same  as  those  existing  in 
South  Carolina.  The  penalty  for  practicing  with- 
out such  license  or  a  diploma  from  some  medical 
college,  was  a  sum  not  exceeding  five  hundred 
dollars  for  each  offense.  But  the  examining 
boards  were  all  abolished  some  eight  or  ten  years 
since,  which  operated  as  a  repeal  of  all  law  on 
the  subject.  The  medical  laws  of  the  state  of 
Mississippi  are  coeval  with  the  existence  of  the 
state  itself.  They  provided  for  the  establishment 
of  three  boards  of  examiners,  appointed  by  the 
state  legislature.  These  boards  were  required  to 
examine  all  candidates  for  permission  to  practice 
medicine  and  surgery  in  their  respective  districts, 
whether  graduates  of  a  medical  college  or  not, 
and  grant  licenses  to  such  as  they  found  qualified. 
By  an  act  passed  in  1827,  all  licenses  were 
required  to  be  filed  in  the  clerk's  office  of  the 
county  where  the  holder  of  said  license  should 
commence  practice,  within  six  months  from  the 


MRDIOAh    HISTORY.  101 

lime  of  such  commencement.  All  attempts  to 
practice  without  procuring  a  license  from  one  of 
the  examining  boards,  and  having  it  duly  recorded 
in  the  clerk's  office,  was  punishable  by  .a  fine  not 
exceeding  five  hundred  dollars,  and  imprisonment 
not  exceeding  six  months.  It  was  further  made 
the  duty  of  the  county  clerk  to  present  a  complete 
list  of  all  licenses  recorded  in  his  office  to  the 
grand  jury  of  each  county  court ;  and  such  grand 
jury  were  required  to  present  to  the  court  all  such 
persons  as,  from  their  own  knowledge,  or  from 
information  given  by  others,  were  practicing 
physic  or  surgery  without  a  license.  In  1829, 
another  act  was  passed  by  the  legislature,  autho- 
rizing the  establishment  of  a  "Medical  Society  of 
the  State  of  Mississippi."  These  laws  were  very 
complete,  and  effectually  accomplished  the  object 
for  which  they  were  designed.  Bat  when  the 
state  constitution  was  revised  in  1834,  the  several 
boards  of  examiners  were  omitted,  which  operated 
as  a  repeal  of  all  restraints  on  the  practice  of 
medicine  in  that  state ;  and  though  the  state  medical 
society  has  maintained  its  organization,  yet,  since 
the  year  1834,  there  have  been  no  legal  provisions 
for  discouraging  quackery  in  any  of  its  forms. 
The  first  laws  relating  to  the  practice  of  physic 
and  surgery  in  Louisiana,  were  passed  in  1808. 
They  were  revised  and  amended  in  1816-17-20, 


102  MEDICAL    HISTORY. 

In  the  latter  year,  two  medical  boards  were  estab- 
lished, one  for  each  supreme  judicial  district  in  the 
state.  These  boards  were  composed  of  six  mem- 
bers each,  appointed  by  the  governor,  with  the 
advice  and  consent  of  the  senate,  with  one  apo- 
thecary attached  to  the  board  in  the  first  district. 
These  boards  Avere  to  examine  all  applicants  for 
license  to  practice  in  their  respective  districts, 
and  license  such  as  were  found  qualified ;  but 
such  as  had  graduated  at  a  respectable  medical 
college  were  permitted  to  obtain  a  license  on  ex- 
hibiting their  diploma,  without  an  examination. 
The  apothecary  attached  to  the  board  in  the  first 
district,  was  to  examine  and  license  apothecaries, 
who  were  under  the  same  regulations  as  practic- 
ing physicians.  The  penalties  prescribed  for  vio- 
lating the  laws  of  this  state,  by  practicing  without 
a  license,  were  a  fine  of  one  hundred  dollars  for 
the  first  offense ;  and  for  the  second,  a  fine  not  ex- 
ceeding two  hundred  dollars,  and  imprisonment 
not  more  than  one  year.  The  attorney-general 
was  required  to  prosecute  for  all  violations  of  the 
laws.  The  licenses  were  required  to  be  filed  in 
the  parish  or  county-clerk's  office,  the  same  as  in 
Mississippi.  A  state  medical  society  was  incor- 
porated in  Tennessee,  in  1830,  \vith  a  board  of 
censors  authorized  to  examine  and  license  all  per- 
sons who  may  present  themselves  for  examination, 


MEDICAL    HISTORV,  103 

touching  their  -skill  in  the  practice  of  medi- 
cme  and  surgery.  No  term  of  study,  or  other 
preliminary  condition,  is  required  of  the.applicant, 
except  that  he  be  twenty-one  years  of  age,  and  of 
good  moral  character ;  and  no  penalties  are  pro- 
vided against  practicing  without  a  license. 

The  legislatures  of  Ohio,  Indiana,  and  Michi- 
gan, have  all  passed  laws  incorporating  state  and 
county  or  district  medical  societies,  with  power 
to  appoint  censors,  and  license  candidates  to 
practice  much  the  same  as  in  New  York.  These 
laws  also  laid  some  moderate  restrictions  on  un- 
licensed and  irregular  practitioners  ;  but,  as  in 
most  of  the  older  states,  all  these  restrictions 
have  been  repealed  within  the  last  ten  years, 
leaving  the  regularly  organized  societies  to  main- 
tain the  honor  of  the  profession,  and  protect  the 
interests  of  the  community  as  best  they  could. 

From  the  hasty  glance  we  have  now  taken  of 
medical  legislation  throughout  the  Union,  it  will 
be  observed  that,  during  the  first  quarter  of  the 
nineteenth  century,  the  legislatures  of  all  the 
older  states,  except  Pennsylvania,  Virginia  and 
North  Carolina,  enacted  laws  for  the  avowed  pur- 
pose of  protecting  the  citizens  against  the  impo- 
sitions of  ignorance  and  empiricism,  and  of  pro- 
moting medical  science.  That  these  were  the 
real  motives  for  enacting  laws  on  this  subject,  and 


104  MEDICAL    HISTORY. 

especially  the  first  one  named,  that  of  protecting 
the  citizens  against  imposition,  is  abundantly 
shown  by  the  preambles  and  titles  attached  to  the 
several  acts  themselves. 

The  idea  of  protecting  the  profession,  or  invest- 
ing it  with  special  privileges,  seems  to  have  been 
the  discovery  of  a  later  period,  as  we  shall  see  in 
the  sequel.  Again,  the  business  of  examining  and 
licensing  candidates  for  admission  into  the  ranks 
of  the  profession,  was  not  only  uniformly  com- 
mitted to  medical  men,  but,  with  very  few  excep- 
tions, those  men  were  also  selected  by  the  profes- 
sion, or  rather  by  regularly  organized  medical 
societies.  Another  important  fact  is,  that  during 
this  period,  medical  societies  were  regularly  or- 
ganized in  almost  every  state  in  the  Union  ;  hence 
the  same  effects  that  we  have  ascribed  to  the 
medical  organization  of  New  York,  was  felt  to  a 
greater  or  less  extent  throughout  flie  whole  Union. 
The  intercourse  between  medical  men  was  every- 
where more  dignified,  medical  intelligence  was 
more  rapidly  and  generally  diffused,  the  importance 
of  a  good  knowledge  of  anatomy,  physiology,  and 
chemistry  became  better  appreciated,  and  in  the 
same  proportion,  medical  colleges  were  more  gene- 
rally patronized,  and  medical  literature  cultivated. 
Such  were  the  legitimate  and  highly  beneficial  in- 
fluences exerted  bv  medical  associations  throughout 


MEDICAL    HISTORY.  105 

the  country.  The  number  of  graduates  from 
medical  colleges  during  the  earlier  part  of  this 
period  was  comparatively  small,  and  in  some  of  the 
states  even  those  were  obliged  to  procure  licenses 
before  entering  into  practice — far  the  larger  share 
of  those  who  entered  the  regular  profession  being 
examined  and  licensed  by  the  boards  of  censors, 
appointed  by  state  or  district  medical  societies — 
a  considerable  fund  was  thus  derived,  which,  in 
most  instances,  was  appropriated,  as  in  New  York, 
to  the  support  of  the  several  societies,  and  the 
promotion  of  their  legitimate  objects ; — hold- 
ing thus,  as  it  were,  the  keys  of  the  profession, 
and  aided,  to  some  extent,  by  the  funds  derived 
from  licenses,  the  medical  organization  of  the 
several  states  and  districts  was  actively  and  vigo- 
rously sustained. 

The  organization  of  medical  societies  through- 
out the  Union,  also  brought  into  beneficial  action 
another  powerful  stimulant  to  human  enterprise 
— viz.,  ambition.  Every  society,  whether  county," 
district,  or  state,  must  have  its  official  stations, 
its  posts  of  honor  ;  and  hence,  every  right-minded 
member  of  those  societies  would  be  so  influenced 
in  his  conduct  as  to  gain  the  esteem  and  confi- 
dence of  his  professional  brethren,  without  which 
he  could  not  hope  to  be  honored  by  them.  But 
while  the  internal  organization  of  the  profession 


106  MEDICAL    HISTORY. 

was  thus  rapidly  improving  its  character  and 
influence,  other  'agencies  were  brought  into 
operation,  some  of  which  exerted  a  widely  diffe- 
rent effect,  both  on  the  profession  and  the  com- 
munity. 

At  the  commencement  of  the  period  now  under 
consideration,  only  about  five  hundred  students 
were  in  attendance  on  the  lectures  in  the  four  or 
five  medical  colleges  then  existing  in  the  Union, 
and  the  whole  number  of  graduates  for  the  year 
1807  did  not  exceed  fifty.  No  sooner,  however, 
did  the  study  of  anatomy,  physiology,  chemistry, 
etc.,  become  better  appreciated  through  the  in- 
fluences already  detailed,  than  the  students  at- 
tending the  colleges  began  rapidly  to  increase, 
and  the  number  of  colleges  increased  also.  The 
small  degree  of  prosperity  which  attended  the 
Medical  Department  of  Columbia  College,  led 
many  members  of  the  profession  to  use  their  in- 
fluence to  establish  another  college  in  that  city. 
Accordingly  the  regents  of  the  University  of  New 
York  granted  a  charter  for  a  new  college  in  1807, 
called  the  "  College  of  Physicians  and  Surgeons 
of  New  York."  This  school  was  placed  under 
the  direction  of  a  board  of  trustees,  consisting  of 
the  whole  medical  society  of  the  city  and  county 
of  New  York,  and  the  degree  of  M.D.  was  con- 
ferred by  the  regents  of  the  University  of  the 


MEDICAL    HISTORY.  107 

state,  on  the  recommendation  of  the  trustees  and 
faculty  of  the  College.  The  first  course  of  lec- 
tures was  given  in  the  winter  of  1807-8,  to  a 
class  of  fifty-three  students,  and  was  continued 
regularly  thereafter  until  the  present  time. 

In  1810,  the  Medical  Department  of  Columbia 
College  was  finally  discontinued,  leaving  the  Col- 
lege of  Physicians  and  Surgeons  the  only  one  in 
the  state,  with  a  class  of  students  numbering 
eighty-two.  But  instead  of  that  rapid  prosperity 
which  the  friends  of  the  institution,  and  the  re- 
gents of  the  University  now  anticipated,  the  very 
numerous  board  of  trustees,  being  mostly  medical 
practitioners  in  the  immediate  vicinity  of  the 
college,  soon  became  distracted  by  opposing  coun- 
cils, and  jealousies  between  them  and  the  mem- 
bers of  the  faculty,  which  caused  much  difficulty, 
and  greatly  retarded  both  the  prosperity- of  the 
college,  and  the  progress  of  medicine,  in  that  city. 

The  Medical  Department  of  the  University  of 
Maryland,  in  Baltimore,  was  incorporated  by  the 
legislature  of  that  state  in  1807,  and  was  soon 
supplied  with  an  able  faculty,  and  has  continued 
to  enjoy  a  fair  share  of  public  confidence  and 
prosperity  until  the  present  time. 

In  1810,  a  medical  department  was  attached  to 
Yale  College,  at  New  Haven,  but  the  first  course 
of  lectures  was  not  delivered  until  the  winter  of 


108  MEDICAL    HISTOKY. 

1813-14,  since  which  time  they  have  been  regu- 
larly continued,  the  class  usually  numbering  be- 
tween fifty  and  one  hundred,  and  the  number  of 
graduates  varying  from  three  to  twenty-nine 
annually. 

The  next  medical  institution  established  in  the 
country  was  at  Fairfield,  Herkimer  County,  New 
York,  in  1 8 1 2,  called  the  "College  of  Physicians  and 
Surgeons  of  the  Western  District."  It  was  char- 
tered  by  the  regents  of  the  state,  with  the  same  pow- 
ers and  duties  as  the  College  of  Physicians  and 
Surgeons  of  the  city  of  New  York.  The  degrees 
were  conferred  by  the  regents  on  the  recommenda- 
tion of  the  faculty  and  trustees  of  the  college. 
The  first  course  of  lectures  was  given  in  the  win- 
ter of  1813-14,  to  a  class  of  thirty-three  students. 
The  course  of  this  institution  was  marked  by  a 
pretty  uniform  degree  of  prosperity  until  1834, 
when  the  class  numbered  two  hundred  and  seven- 
teen. From  this  period  it  began  gradually  to  de- 
cline, owing  to  the  influence  of'  neighboring 
schools,  and  in  1840  the  whole  faculty  resigned 
their  places,  and  no  successors  were  appointed. 

Two  new  colleges  were  established  in  1818, 
one  at  Castleton,  Vermont,  called  the  "  Vermont 
Academy  of  Medicine,"  and  the  other  at  Lexing- 
ton, Kentucky,  called  the  "Medical  School  of 
Transylvania  University."  The  degrees  of 


MEDICAL    HISTORY.  109 

Castleton  Medical  School  were  conferred  by 
Middlebury  College  until  1828,  since  which  time 
they  have  been  conferred  by  the  college  under  its 
independent  charter.  The  number  of  students  in 
attendance  have  varied  from  twenty- four,  in  1818, 
to  one  hundred  and  thirty,  in  1836,  and  the  num- 
ber of  graduates  averaged  about  twenty-five  an- 
nually .Since  1835,  two  courses  of  lectures  have 
been  given  annually  ;  one  in  the  spring  and  an- 
other in  the  fall.  The  Transylvania  Medical 
School  rapidly  attained  a  high  degree  of  prospe- 
rity, the  number  of  students  averaging  over  two 
hundred  annually,  and  the  graduates  varying  from 
seven,  in  1820,  to  eighty-three,  in  1835. 

The  Medical  College  of  Ohio  was  incorporated 
in  1819,  located  at  Cincinnati,  and  has  continued 
with  a  fair  share  of  prosperity  until  the  present 
time. 

In  the  following  year,  the  Medical  School  of 
Maine  was  established  at  Brunswick,  in  connection 
with  Bowdoin  College.  The  first  course  of  lec- 
tures was  delivered  in  1821,  to  a  class  of  twenty- 
one  students,  while  in  1836  the  number  had  in- 
creased to  one  hundred,  and  the  number  of  gra- 
duates to  twenty-seven.  The  medical  school  at- 
tached to  Brown  University,  at  Providence, 
Rhode  Island,  was  established  in  1821,  but  was 
discontinued  after  a  few  years.  In  the  year 


110  MEDICAL    HISTORY. 

following,  the  Medical  School  of  the  University  of 
Vermont  was  commenced  at  Burlington,  but  was 
also  discontinued  previous  to  1840.  The  Berk- 
shire Medical  School  was  established  at  Pittsfield, 
Massachusetts,  in  1823,  and  has  continued  its 
annual  courses  of  lectures  to  classes  varying  from 
seventy-three  to  one  hundred  and  seventeen, 
until  the  present  time. 

The  next  medical  college  established  in  the 
country  was  at  Charleston,  South  Carolina,  in 
1824,  called  the  "Medical  College  of  South  Ca- 
rolina." This  school  appears  to  have  been  under 
the  control  of  the  medical  society  of  the  state, 
and  enjoyed  a  fair  share  of  public  patronage  until 
dissensions  arose  between  the  faculty  and  the 
governing  body,  which  caused  the  former  to  re- 
sign their  places  in  1832.  Their  places  were  im- 
mediately filled,  and  the  annual  courses  of  in- 
struction continued,  but  to  a  greatly  reduced  class, 
for  several  years,  in  the  meantime,  the  profes- 
sors who  had  resigned  obtained  from  the  state 
legislature,  in  1833,  a  charter  for  another  school 
in  the  same  city,  called  the  "  Medical  College  of 
the  state  of  South  Carolina.."  The  first  class 
attending  the  new  college  in  the  winter  of  1833-4, 
numbered  one  hundred  and  three,  and  the  school 
seems  to  have  sustained  a  fair  degree  of  prospe- 
rity up  to  the  present  period.  During  the  year 


MEDICAL,    HISTORY.  Ill 

1824,  another  school  of  medicine  was  also  estab- 
lished in  Philadelphia,  called  the  "  Jefferson  Me- 
dical College."  But  the  first  course  of  lectures 
was  given  in  the  winter  of  1825-6,  to  a  class  of 
one  hundred  and  ten  students.  It  has  since  ac- 
quired a  degree  of  popularity,  second  only  to  that 
of  the  University  of  Pennsylvania,  so  long  estab- 
lished in  the  same  city. 

In  1825,  two  other  colleges  were  established, 
viz. — the  Medical  School  of  Columbian  College,  in 
the  district  of  Columbia,  and  the  Medical  School 
of  the  University  of  Virginia,  at  Charlottsville. 
The  organization  of  this  latter  school  is  somewhat 
peculiar.  Its  periods  of  instruction  continue 
through  ten  months  of  each  year,  and  all  the 
branches  are  taught  by  three  professors,  in  much 
the  same  manner  as  other  sciences  are  taught  in 

O 

collegiate  institutions.  The  number  of  medical 
students  in  attendance,  in  1835-6,  was  sixty-three. 
The  Washington  Medical  College  was  established 
at  Baltimore,  Maryland,  in  1827,  its  degrees  being 
conferred  by  Washington  College,  in  Pennsyl- 
vania until  1833,  when  it  obtained  a  regular  char- 
ter from  the  legislature  of  Maryland.  In  1834, 
the  number  of  graduates  was  only  ten,  and  in 
1838—9,  the  whole  number  of  students  was  fifty- 
three. 

The  next  medical  institution  was  the  "  Medical 


112  MEDICAL    HISTORY. 

College  of  Georgia,"  located  at  Augusta,  and  in- 
corporated in  1830.  The  first  course  of  lectures, 
however,  was  not  given  until  the  winter  of  1832-3, 
when  twenty-seven  students  were  in  attendance. 
In  1834,  the  Willoughby  University,  at  Willough- 
by,  Ohio,  was  incorporated,  and  supplied  with  a 
medical  faculty,  who  gave  their  first  course  of  lec- 
tures in  the  winter  of  1835-6  to  a  class  of  twenty- 
three  students.  It  enjoyed  a  moderate  degree  of 
prosperity  until  the  year  1847,  when  the  medical 
department  was  transferred  to  Columbus,  and  re- 
organized under  the  name  of  the  "  Starling  Medi- 
cal College,"  in  honor  of  Lyne  Starling,  who 
made  the  very  liberal  donation  of  thirty  thousand 
dollars  for  the  benefit  of  the  institution,  and  five 
thousand  dollars  more  for  the  establishment  of  an 
hospital. 

Dm-ing  the  year  1835,  no  less  than  four  medical 
schools  were  added  to  the  number  already  estab- 
lished in  the  Union,  viz. — the  Medical  College  of 
Louisiana,  at  New  Orleans ;  the  Medical  Institu- 
tion of  Geneva  College,-  at  Geneva,  New  York  ; 
the  Medical  Department  of  Cincinnati  College,  at 
Cincinnati,  Ohio;  and  the  Vermont  Medical 
School  at  Woodstock,  Vermont.  The  Louisville 
Medical  Institute,  at  Louisville,  Kentucky,  and 
the  Medical  Faculty  of  the  University  of  the  City 
of  New  York,  were  established  in  1837,  and  the 


MEDICAL    HISTORY.  113 

Medical  Department  of  Hampden  Sidney  College, 
at  Richmond,  Virginia,  in  1838.  In  the  following 
year,  still  two  more  were  added,  viz. — the  Albany 
Medical  College  at  Albany,  New  York,  and  the 
Medical  Department  of  Pennsylvania  College,  at 
Philadelphia. 

During  the  period  intervening  between  1840 
and  the  present  time  (1850),-no  less  than  thirteen 
new  medical  colleges  have  been  established,  viz. 
— two  at  St.  Louis,  Missouri,  called  the  Univer- 
sity of  Missouri,  and  the  St.  Louis  University  ; 
one  at  Chicago,  Illinois,  called  the  Rush  Medical 
College  ;  one  at  Cleveland,  Ohio,  called  the  West- 
ern Reserve  College ;  one  in  Indiana,  called  the 
Indiana  Medical  College,  located  at  La  Porte ; 
two  in  Philadelphia,  called  the  Philadelphia  Col- 
lege of  Medicine,  and  the  Franklin  Medical  Col- 
lege ;  one  a.t  Buffalo,  New  York,  called  the  Medi- 
cal Department  of  the  University  of  Buffalo  ;  one 
at  Memphis,  Tennessee,  called  the  Memphis  Medi- 
cal Collesre  ;  one  at  Evansville,  and  another  at 

O        * 

Indianapolis,  in  Indiana ;  one  at  Devanport,  Iowa, 
called  the  College  of  Physicians  and  Surgeons  of 
the  Upper  Mississippi ;  and  one  in  Michigan,  lo- 
cated at  Ann  Arbor,  being  a  department  of  the 
University  of  that  state. 

Of  the  forty-three  medical  colleges  which  have 
thus  been  organized,  we  believe  that  seven  have 


J  14  MEDICAL    HISTORY. 

been  wholly  discontinued,  while  others  have 
merely  changed  their  names  or  localities,  leaving 
thirty-six  now  in  active  operation  in  the  United 
States.  Of  these,  seven  are  in  the  eastern  or 
New  England  States,  nine  in  the  middle,  seven 
in  the  southern,  and  thirteen  in  the  western.  It 
will  be  noticed  that  only  six  medical  colleges  were 
organized  prior  to  181Q,  five  between  1810  and 
1820,  eight  between  1820  and  1830,  eleven  be- 
tween 1830  and  1840,  and  thirteen  between  1840 
and  1850.  The  number  of  students  in  attendance 
on  the  several  colleges,  at  each  period  of  ten 
years,  may  be  stated  as  follows,  together  with  the 
number  of  graduates,  viz.  : — 


WHOLE  NUMBER 

OF  STUDENTS. 

GRADUATES. 

In  1810,   - 

-   650 

In  1810,  -   - 

100 

"  1820,   - 

-   964 

"  1820,  -'  - 

182 

"  1830,   - 

•-  2125 

"  1830,  -   - 

597 

"  1840,   - 

-  2800 

"  1S40,  -   - 

775 

"  1850,   - 

-  4500 

"  1850,  -   - 

1300 

These  numbers  are  not  claimed  as  entirely 
accurate,  owing  to  the  difficulty  of  obtaining 
complete  and  reliable  information  on  the  subject ; 
but  they  are  sufficiently  so  for  all  the  purposes  of 
comparison.  They  illustrate  very  clearly  what 
we  have  already  stated  when  detailing  the  organ 


MEDICAL    HISTORY.  115 

ization  of  medical  societies,  viz.,  that  the  medical 
colleges  were  patronized  just  in  proportion  as  the 
importance  of  the  fundamental  branches  of  medi- 
cal science  became  better  and  more  universally 
appreciated,  through  the  medium  of  such  societies. 
Thus,  during  the  ten  years  following  1820,  a 
period  when  the  medical  societies  of  most,  of  the 
states  were  in  their  most  active  and  influential 
state,  the  number  of  students  attending  the  medi- 
cal schools  were  more  than  doubled,  and  the 
number  of  graduates  increased  threefold.  It  is  a 
fact  also  worthy  of  notice,  that  the  number  of 
graduates  have  been  constantly  increasing  faster 
than  the  whole  number  of  students.  Thus,  in 
1810,  the  ratio  of  graduates  to  the  whole  number 
of  students  attending  the  schools,  was  1  to  6,  5 ; 
in  1820,  1  to  5,  3;  in  1830,  1  to  3,  6 ;  in  1840,  1 
to  3,  6 ;  in  1850,  1  to  3,  4. 

But  this  exceedingly  rapid  increase  in  the  num- 
ber of  students  who  resort  to  the  medical  colleges, 
and  the  number  taking  degrees,  by  no  means  in- 
dicate an  equally  rapid  increase  in  the  whole 
number  of  those  pursuing  the  study  of  medicine. 
For,  it  must  be  remembered,  that  medical  exam- 
iners had  been  appointed  in  a  large  majority  of 
the  states  in  connection  with  their  social  organ- 
ization ;  and,  during  the  first  quarter  of  the  present 
century,  a  much  larger  number  of  students  were 


116  MEL'ICAL    HISTORY. 

probably  examined  and  admitted  by  these  nume- 
rous boards  of  examiners  than  by  the  colleges. 
But  a  large  majority  of  the  states  having  made 
the  college  diploma  a  legal  admission  into  the 
profession,  with  all  its  rights  and  privileges,  it 
soon  became  the  paramount  object  of  the  student's 
pursuit.  This,  together  with  the  absence  of  all 
preliminary  requisites  in  regard  to  general  educa- 
tion, and  the  many  facilities  afforded  by  the  rapid 
multiplication,  and  consequent  competition  of  the 
colleges  with  each  other,  caused  the  licenses  from 
local  examining  boards  to  be  comparatively  ne- 
glected. Thus,  in  1820,  only  thirty-eight  students 
received  the  degree  of  M.D.  from  the  medical 
colleges  of  the  state  of  New  York,  while  three 
times  that  number  were  examined  and  licensed 
by  the  censors  of  the  state  and  county  societies. 
In  1830,  the  graduates  from  the  medical  colleges 
of  the  same  state  numbered  fifty-six,  those  licensed 
by  the  censors  of  the  state  society,  seventeen,  and 
probably  one  hundred  more  by  the  numerous 
county  boards.  While,  in  1846,  the  whole  number 
of  graduates  in  the  state  was  two  hundred  and 
forty-six,  the  number  licensed  by  the  censors  of 
the  state  society  was  only  three,  and  those 
reported  by  the  county  societies,  five.  Although 
it  is  quite  probable  that  a  few  were  licensed  by 
the  county  societies  who  were  not  reported  to 


ill  £D  It;  A  Li 


the  state  society,  yet  the  whole  number  for  two 
or  three  years  previous  had  not  averaged   ten 
annually.     The  effects  of  this  rapid  change  were 
twofold.     The    local    societies   being    gradually 
deprived   of    the   funds   derived    from   granting 
licenses,  soon  found  their  libraries  neglected,  and 
their  regular  meetings  diminishing  both  in  interest 
and  in  the  numbers  in  attendance.     This  gave 
rise  to  a  general  feeling  of  indifference  on  the  part 
of  the  profession,  during  the  prevalence  of  which 
many  local  societies  ceased  to  maintain  an  active 
existence  ;    and   whatever   laws   for   restraining 
quackery  had  been  enacted  by  the  legislatures  of 
the  several  states,  were,  with  very  few  exceptions, 
repealed.     While,  on  the  other  hand,  the  great 
increase  of  patronage  bestowed  on  the  medical 
schools,  literally  begot  a  mania  for  college  making. 
And  this  mania  was  rendered  still  more  intense 
by  the  regulations  almost  universally  adopted  as 
requisites  both  for  graduation  and  license.    These 
gave  no  credit  for  any  courses  of  instruction,  how- 
ever  extensive   and   complete,   except    such   as 
should    be   delivered    in   a  regularly-established 
college.     Hence,  every  professional  man  who  be- 
came ambitious  of  distinction  as  a  teacher,  sought 
a  professorship  in  some  college  as  the  only  posi- 
tion in  which  that  ambition  could  be  gratified. 
And  as  there  are  always  more  such  men  than 


118  MEDICAL    HISTORY. 

there  are  places  for  them  to  fill,  the  constant  and 
inevitable  tendency  is  to  the  creation  of  more 
places.  If  the  state  legislature,  to  whom  applica- 
tion is  made  for  an  act  of  incorporation,  happens 
to  be  so  stupid  as  not  to  perceive  the  necessity  of 
establishing  a  new  school,  a  bargain  is  soon 
struck  with  some  literary  college,  already  possess- 
ing the  right  to  confer  degrees,  to  furnish  the 
necessary  diplomas,  and  straightway  a  new  medi- 
cal college,  with  all  the  usual  honors  and  privi- 
leges, springs  into  existence.  To  so  great  an 
extent  has  this  spirit  been  carried,  that  scarcely  a 
single  year  has  passed  since  1830,  without  wit- 
nessing the  birth  of  one  or  more  of  these  institu- 
tions. If  the  standard  of  preliminary  education 
had  been  elevated,  and  the  requisites  for  gradua- 
tion increased  in  proportion  to  the  multiplication 
of  schools,  no  evils  would  have  resulted  to  the 
profession  or  the  community ;  but,  there  being 
practically  no  standard  of  preliminary  education, 
and  the  professors,  with  only  two  or  three  excep- 
tions, being  the  sole  judges  of  the  student's  quali- 
fications, the  addition  of  every  new  college  only 
served  to  increase  the  competition,  and  add  to 
the  facilities  for  obtaining  diplomas.  Indeed,  to 
such  an  extent  has  this  spirit  and  practice  been 
carried,  that  any  young  man  can  obtain  the  once 
hidi  and  honorable  title  of  M.  D.  for  a  less 


MEDICAL    HISTORY.  119 

expenditure  of  time  and  labor  than  it  takes  to 
obtain  the  primary  literary  title  of  A.B. 

It  is  true  that  the  professors  in  many  of  the 
colleges  would  gladly  have  stayed  this  tendency 
of  things  ;  but  it  was  not  in  their  power.  Hence, 
with  only  two  or  three  recent  exceptions,  eight 
months'  attendance  on  a  medical  college — three 
years'  study,  including  the  eight  months — twenty- 
one  years  of  age — and  a  thesis  on  some  medical 
snbject,  constitute,  practically,  all  the  qualifica- 
tions required  of  the  candidate  for  medical  honors, 
previous  to  his  examination. 

If  we  contrast  these  with  the  qualifications 
required  in  other  countries,  or  with  those  origin- 
ally required  by  the  founders  of  the  old  school  in 
Philadelphia,  we  shall  cease  to  be  surprised  either 
at  the  crowded  state  of  the  profession,  or  at  the 
heteroo;enous  mixture  of  all  grades,  characters,  and 

o  o 

degrees  of  attainment  which  it  presents.  The 
impossibility  of  any  faculty  of  five  or  six  profes- 
sors doing  anything  like  justice  to  the  whole  field 
of  medical  science  in  the  short  space  of  four 
months,  to  say  nothing  of  the  perfect  absurdity  of 
attempting  to  crowd  an  amount  of  material  so 
vast  and  varied  on  the  mind  of  the  student  in  so 
short  a  space  of  time,  early  attracted  the  attention 
of  many  enlightened  members  of  the  profession, 
among  whom  were  some  of  the  ablest  professors 


120  MEDICAL  HISTOttY. 

connected  with  our  schools.  Hence,  attempts 
were  made  from  time  to  time  to  extend  the 
courses  of  college  instruction,  and  elevate  the 
standard  of  medical  attainments ;  but  so  rapid 
was  the  increase  of  new  schools,  and  so  active 
the  rivalship,  that  every  attempt  to  produce  con- 
cert of  action  among  the  schools  of  even  a  limited 
number  of  states  proved  abortive.  We  believe 
the  earliest  of  these  efforts  was  made  by  the 
colleges  of  New  England,  some  of  whom,  in  good 
faith,  carried  into  practice  an  agreement  to  extend 
their  courses  of  instruction ;  but  others,  wholly 
neglecting  the  movement,  soon  induced  all  to 
return  to  the  former  limits. 

In  1835,  the  faculty  connected  with  the  Medi- 
cal College  of  Georgia  called  the  attention  of 
their  professional  brethren  to  the  same  subject ; 
and,  both  by  correspondence  and  through  the 
columns  of  the  Southern  Medical  and  Surgical 
Journal,  urged  the  propriety  of  a  national  con- 
vention of  delegates  from  all  the  colleges,  not 
only  to  agree  upon  a  longer  term  of  instruction, 
but  also  upon  a  higher  standard  of  medical  edu- 
cation. These  efforts  were  favorably  responded 
to  by  a  large  proportion  of  the  colleges  then  exist- 
ing, but  the  time  and  place  for  holding  the  con- 
vention was  left  to  the  medical  faculty  of  the 
University  of  Pennsylvania,  who,  by  declining  to 


MEDICAL    HISTORY.  121 

take  any  action  on  the  subject,  effectually  ar- 
rested the  whole  movement.  Notwithstanding 
this  failure,  the  able  efforts  of  the  Medical 
Faculty  of  the  Georgia  School  were  not  wholly 
in  vain ;  for  they  served,  in  no  small  degree,  to 
arouse  the  attention  of  the  profession  generally 
to  a  subject,  of  so  much  importance.  Hence, 
articles  in  medical  journals,  and  resolutions 
adopted  by  medical  sdcieties,  touching  the  subject, 
continued  occasionally  to  make  their  appearance. 
The  following  preamble  and  resolution,  offered 
by  Dr.  John  M'Call,  of  Utica,  were  adopted  by 
the  Medical  Society  of  the  State  of  New  York, 
at  its  annual  session,  in  February,  1839,  viz. — 
"  Whereas,  a  National  Medical  Convention 
would  advance,  in  the  apprehension  of  this  so- 
ciety, the  cause  of  the  medical  profession  through- 
out our  land,  in  thus  affording  an  interchange  of 
views  and  sentiments  on  the  most  interesting  of 
all  subjects — that  involving  men's  health,  and  the 
means  of  securing  or  recovering  the  same :  there- 
fore, Resolved,  That,  in  our  opinion,  such  con- 
vention is  deemed  advisable  and  important ;  and 
we  would  hence  recommend  that  it  be  held  in  the 
year  1840,  on  the  first  Tuesday  in  May  of  that 
year,  in  the  city  of  Philadelphia, — and  that  it 
consist  of  three  delegates  from  each  state  medi- 
cal society,  and  one  from  each  regularly 


122  MEDICAL    HISTORY. 

constituted  medical  school  in  the  United 
States,  and  that  the  president  and  secretary  of  this 
society  be,  and  they  are  hereby  instructed  and  re- 
quired to  transmit,  as  soon  as  may  be,  a  circular 
to  that  effect  to  each  state  medical  society  and 
medical  school  in  said  United  States." 

This  proposition  was  sanctioned  by  so  many 
of  the  societies  and  colleges  in  other  states,  that 
the  New  York  Society,  at  its  next  annual  meet- 
ing, in  February,  1840,  appointed  three  delegates, 
one  or  two  of  whom  proceeded  to  Philadelphia  at 
the  appointed  time,  where  they  met  one  delegate 
from  Ohio,  and  one  from  one  of  the  Eastern  states. 
But,  finding  no  others,  not  even  a  local  delega- 
tion from  any  of  the  medical  institutions  of  Phi- 
ladelphia itself,  they  returned  without  accomplish- 
ing  any  of  the  objects   for  which  they  went. 
Medical  education,  however,  continued  to  be  a 
topic  of  discussion  in  the  medical  periodicals  of 
the  country,  as  well  as  the  theme  for  many  intro- 
ductory and  valedictory  lectures  in  the  colleges  ; 
and  every  succeeding  year  only  served  to  make 
the  defects  and  evils  of  the  present  system  more 
prominent,  and  the  necessity  of  some  general  and 
harmonious  action  on  the  subject,  more  apparent. 
At  the  annual  meeting  of  the  New  York  State 
Society,  in  February,   1844,  several  resolutions, 
having  for  their  object  an  elevation  of  the  stand- 


MEDICAL    HISTORY.  123 

ard  of  medical  education  in  that  state,  and  the 
establishment  of  a  more  uniform  and  perfect 
system  of  examinations,  were  introduced  ;  some 
by  Dr.  Alexander  Thompson,  of  Cayuga  county, 
and  some  by  the  author  of  this  work.  After  a 
short  discussion,  the  whole  subject  was  referred 
to  the  Committee  of  Correspondence,  with  in- 
structions to  report  at  next  annual  meeting ;  and, 
in  the  meantime,  to  address  circulars  to  the  seve- 
ral county  societies,  asking  their  views  on  the 
same  subject.  Accordingly,  at  the  next  annual 
meeting  of  the  society,  two  reports  were  made, 
one  by  myself,  as  chairman  ^of  the  committee, 
zealously  advocating  reform,  and  a  minority  re- 
port, by  Di*.  M.  H.  Cash,  of  Orange  county.  -  The 
resolutions  appended  to  these  reports  underwent 
a  lengthy  and  animated  discussion,  during  which 
it  was  admitted  by  all  parties  that  the  standard  of 
medical  education  was  too  low,  and  that  the  num- 
ber of  tribunals  authorized  to  examine  and  license 
candidates,  or,  in  other  words,  the  number  of 
avenues  into  the  'profession,  were  too  great  and 
too  diversified  ;  while,  on  the  other  hand,  it  was 
urged  with  much  force,  especially  by  those  di- 
rectly interested  in  the  medical  schools  of  the 
state,  that  the  standard  in  that  state  was  as  high 
as  in  any  of  the  surrounding  states ;  and,  there- 
fore, any  measures  for  exacting  of  the  candidates 


124  -'MEDICAL  HISTORY. 

for  admission  into  the  profession,  higher  qualifi- 
cations, instead  of  accomplishing  the  objects  de- 
sired, would  only  serve  to  drive  students  from 
their  own  institutions  to  those  of  other  states, 
over  which  they  could  have  no  control.  It  was 
at  the  close  of  this  debate,  after  the  writer  had 
been  vainly  striving  to  obviate  the  foregoing  ob- 
jection, that  Professor  March,  of  Albany,  sug- 
gested to  me  that  the  difficulty  might  be  over- 
come by  getting  the  profession  in  all  the  states 
to  act  in  concert.  The  suggestion  was  no  sooner 
received  than  I  rose  and  submitted  the  following 
preamble  and  resolutions,  viz. : 

"  Whereas,  it  is  believed  that  a  National  Con- 
vention would  be  conducive  to  the  elevation  of 
the  standard  of  medical  education  in  the  United 
States ;  and  whereas,  there  is  no  mode  of  accom- 
plishing so  desirable  an  object,  without  concert  of 
action  on  the  part  of  the  medical  societies,  col- 
leges, and  institutions  of  all  the  states,  therefore, 

"  Resolved,  That  the  New  York  State  Medical 
Society  earnestly  recommend  a  National  Con- 
vention of  delegates  from  medical  societies  and 
colleges  in  the  whole  Union,  to  convene  in  the 
city  of  New  York,  on  the  first  Tuesday  in  May, 
in  the  year  1846,  for  the  purpose  of  adopting 
some  concerted  action  on  the  subject  set  forth  in 
the  foregoing  preamble. 


MEDICAL    HISTORY.  125 

"  Resolved,  that  a  committee  of  three  be  ap- 
pointed to  carry  the  foregoing  resolution  into 
effect." 

This  proposition  was  very  generally  regarded 
as  entirely  Utopian,  and  impossible  of  fulfillment ; 
and  in  proof  of  its  possessing  this  nature,  all  the 
former  attempts  to  assemble  a  National  Conven- 
tion of  medical  men,  and  their  entire  failure,  was 
alluded  to  by  some  of  the  oldest  and  ablest  mem- 
bers of  the  society.  Still,  feeling  some  of  the 
warmth  excited  by  the  previous  debate,  instead  of 
yielding  to  discouragements  of  any  kind,  the 
ancient  maxim,  pzrszvzrantia  omnia  vincit,  was 
adopted,  and  the  society  reminded  that  a  project 
which  was  in  itself  good  and  highly  important, 
should  never  be  abandoned  on  account  of  one 
failure,  or  a  dozen.  Besides  this,  the  dilemma 
into  which  many  of  the  society  had  unconsciously 
fallen,  viz. — that  of  contending  during  the  pre- 
ceding discussion,  that  no  higher  standard  of 
medical  attainment  could  be  exacted  in  this  (New 
York)  state,  because  such  standard  was  already 
as  high  as  in  any  of  the  surrounding  states,  and  now 
again  contending  that  the  only  measure  which 
could  bring  the  profession  in  all  the  states  to  ect 
in  concert  was  Utopian  and  impracticable ;  from 
which  the  absurd  conclusion  would  inevitably 
follow,  that  the  cause  of  medical  education  must 


126  MEDICAL    HISTORY. 

remain  indefinitely  in  statu  quo,  was  urged  with 
much  effect. 

After  a  short  discussion,  the  preamble  and  re- 
solutions were  adopted  by  a  large  majority,  and  a 
committee,  consisting  of  Prof.  J.  M'Naughton, 
and  Dr.  Peter  Van  Buren,  of  Albany,  and  myself, 
appointed  to  carry  the  measure  into  effect.  An 
extended  and  laborious  correspondence  was  im- 
mediately commenced  by  me,  as  chairman  of  the 
committee,  and  carried  on  with  such  success,  that 
at  the  next  annual  meeting  of  the  society,  in 
February,  1846,  the  committee  were  enabled  to 
report  a  pledge  of  delegates  from  a  fair  majority 
of  the  medical  societies  and  colleges  in  the  whole 
Union.  Still,  the  societies  and  colleges  in  two  of 
the  most  influential  sections  of  the  country,  viz. 
— Philadelphia  and  Boston,  stood  entirely  aloof 
from  the  movement,  with  the  single  exception  of 
the  Medical  Department  of  Pennsylvania  College, 
whose  faculty  gave  it  a  liberal  and  earnest  sup- 
port. It  appeared,  from  subsequent  correspond- 
ence, that  this  want  of  co-operation  on  the  part 
of  the  profession  in  those  places,  was  not  so  much 
from  a  want  of  interest  in  the  movement,  as  from 
a  false  conception,  arising  from  the  fact,  that  the 
Convention  was  requested  to  meet  in  the  college 
edifice  of  the  New  York  University.  It  was 
thought  that  this  was  calculated  to  attract  the 


MEDICAL    HISTORY.  127 

attention  of  the  profession  to  the  medical  schools 
of  New  York,  and  particularly  to  the  New  York 
University.  Fortunately,  at  this  period,  Profes- 
sor Martyn  Paine,  one  of  the  able  professors  in 
that  school,  published  a  valedictory  address  to  the 
graduating  class  of  the  university,  in  which  he 
denounced,  in  no  measured  terms,  not  only  the 
project  of  a  convention,  but  also,  all  who  were 
engaged  in  promoting  it,  including  the  New  York 
State  Medical  Society  generally,  and  the  chair- 
man of  the  committee  in  particular. 

A  perusal  of  this  address,  which  was  very  ex- 
tensively and  gratuitously  circulated  through  the 
country,  soon  satisfied  all  parties  that  the  con- 
vention was  not,  at  least,  designed  to  promote  the 
interests  of  the  University  of  the  city  of  New 
York.  Hence,  Professor  R.  M.  Huston,  president 
of  the  oldest  medical  society  in  Philadelphia,  very 
soon  convened  the  members  of  that  society, 
which  resulted  in  the  appointment  of  twelve  able 
and  active  delegates  from  that  city.  Thus,  this 
address,  the  style  and  sentiments  of  which  were 
directly  calculated  to  prevent  the  attendance  of 
delegates  from  other  states,  was  made  the  imme- 
diate instrument  of  bringing  in  the  full,  active, 
and  efficient  co-operation  of  that  important  sec- 
tion of  the  Union ;  and  when  the  first  Tuesday 
in  May,  1846,  came,  we  were  gratified  with  the 


128  MEDICAL    HISTORY. 

privilege  of  meeting  in  convention,  in  the  city  of 
New  York,  at  least  one  hundred  delegates,  repre- 
senting medical  societies  and  colleges  in  sixteen 
states  of  the  Union,  viz.  —  Vermont,  New 
Hampshire,  Massachusetts,  Rhode  Island,  Con- 
necticut, New  York,  New  Jersey,  Pennsylvania, 
Delaware,  Maryland,  Virginia,  Georgia,  Missis- 
sippi, Indiana,  Illinois,  and  Tennessee. 

The  convention  was  permanently  organized  by 
the  election  of  Professor  J.  Knight,  of  New 
Haven,  President ;  Di  s.  John  Bell,  of  Phila- 
delphia, and  Edward  Delafield,  of  New  York, 
Vice-Presidents ;  and  Drs.  Richard  D.  Arnold,  of 
Savannah,  and  Alfred  Stille,  of  Philadelphia) 
Secretaries.  The  general  dignity  and  harmony, 
the  spirit  of  forbearance  and  mutual  concession, 
and  the  noble  zeal  for  the  accomplishment  of  the 
objects  for  which  it  had  convened,  which  charac- 
terized the  proceedings  of  this  convention,  was 
no  less  a  disappointment  to  its  enemies,  than  an 
honor  to  the  profession.  All  the  prominent  topics 
connected  with  medical  education  were  appro- 
priately discussed,  and  referred  to  able  commit- 
tees, with  instructions  to  consider  and  report  in 
full  at  an  adjourned  meeting  of  the  convention, 
to  be  held  on  the  first  Wednesday  in  May,  1847, 
in  the  city  of  Philadelphia. 

In  the  mean  time  a  committee,  of  whom  Dr. 


MEDICAL    HISTORY.  129 

J.  Knight,  the  president,  was  made  chairman,  was 
directed  to  issue  an  address  to  the  profession, 
setting  forth  the  objects  of  the  friends  of  the  con- 
vention, and  inviting  a  more  complete  and  uni- 
versal representation  at  the  adjourned  meeting  to 
be  held  in  the  following  May  at  Philadelphia. 
This  duty  was  satisfactorily  performed,  and  a 
nobler  spectacle  was  never  presented  by  the 
medical  profession  of  any  age  or  country  than 
was  witnessed  on  the  assembling  of  the  adjourned^ 
convention  in  1847.  About  two  hundred  and 
fifty  delegates  appeared  and  took  their  seats, 
representing  more  than  forty  medical  societies, 
and  twenty-eight  colleges,  embracing  the  medical 
institutions  of  twenty-two  states,  and  those  of  the 
district  of  Columbia,  viz.,  New  Hampshire,  Ver- 
mont, Massachusetts,  Rhode  Island,  Connecticut, 
New  York,  New  Jersey,  Pennsylvania,  Delaware, 
Maryland,  Virginia,  South  Carolina,  Georgia, 
Mississippi,  Louisiana,  Missouri,  Illinois,  Indiana, 
Michigan,  Ohio,  Kentucky,  and  Tennessee. 

This  second  convention  was  organized  by  the 
election  of  Dr.  Jonathan  Knight,  president ;  Dr. 
Alexander  H.  Stevens,  New  York,  Dr.  George  B. 
Wood,  Pennsylvania,  Dr.'A,  H:  Buchanan,  Ten- 
nessee, Dr.  John  Harrison,  Louisiana,  vice-presi- 
dents ;  and  Dr.  Richard  D.  Arnold,  Georgia,  Dr. 

Alfred    Stille,   Pennsylvania,   Dr.   F.    Campbell 
6* 


130  MEDICAL  HISTO11Y. 

Stewart,  New  York,  secretaries.  All  the  com- 
mittees appointed  at  the  previous  convention 
reported  promptly,  and  their  reports,  with  one 
exception,  were  adopted.  The  committee  on  a 
standard  of  preliminary  education  proper  to  be 
required  of  the  student  before  commencing  the 
study  of  medicine,  of  which  Dr.  J.  Couper,  of 
Newcastle,  Delaware,  was  chairman,  concluded 
their  report  with  the  following  resolutions  : — 

"  Resolved,  That  this  convention  earnestly 
recommend  to  the  members  of  the  medical  pro- 
fession throughout  the  United  States,  to  satisfy 
themselves,  either  by  personal  inquiry  or  written 
certificate  of  competent  persons,  before  receiving 
young  men  into  their  offices  as  students,  that  they 
are  of  good  moral  character,  and  that  they  have 
acquired  a  good  English  -education,  a  knowledge 
of  natural  philosophy,  and  the  elementary  mathe- 
matical sciences,  including  geometry  and  algebra, 
and  such  an  acquaintance,  at  least,  with  the  Latin 
and  Greek  languages  as  will  enable  them  to  appre- 
ciate the  technical  language  of  medicine,  and  read 
and  write  prescriptions." 

"  Resolved,  That  this  convention  also  recom- 
mends to  the  members  of  the  medical  profession 
of  the  United  States,  when  they  have  satisfied 
themselves  that  a  young  man  possesses  the  quali- 
fications specified  in  the  preceding  resolution,  to 


MEDICAL    HISTORY.  131 

give  him  a  written  certificate  stating  that  fact, 
and  recording  also  the  date  of  his  admission  as  a 
medical  student,  to  be  carried  with  him  as  a  war- 
rant for  his  reception  into  the  medical  college  in 
which  he  may  intend  to  pursue  his  studies." 

"  Resolved,  That  all  the  medical  colleges  in  the 
United  States  be,  and  they  are  hereby  recom- 
mended and  requested  to  require  such  a  certifi- 
cate of  every  student  of  medicine  applying  for 
matriculation ;  and  when  publishing  their  annual 
lists  of  graduates,  to  accompany  the  name  of  the 
graduate  with  the  name  and  residence  of  his  pre- 
ceptor, the  name  of  the  latter  being  clearly  and 
distinctly  presented  as  certifying  to  the  qualifica- 
tion of  preliminary  education." 

These  resolutions  were  adopted  by  the  conven- 
tion with  much  unanimity ;  and  they  have  since 
received  the  sanction  and  warm  approval  of 
almost  every  medical  society  whose  members 
have  been  regularly  convened  since  the  adjourn- 
ment of  the  former  body.  The  following  facts, 
taken  from  the  report  of  this  committee,  will 
show  the  condition  of  the  profession  in  this  re- 
spect at  the  commencement  of  that  year: — 
"  The  committee  have  been  favored  with  very 
full  and  explicit  answers  to  their  circular  from 
thirty-nine  gentlemen,  representing  twenty-one 
states  of  the  Union.  The  replies  which  have  been 


132  MEDICAL    HISTORY. 

received  to  the  first  three  questions  establish  the 
fact,  not  only  that  there  is  no  uniform  standard 
of  preparatory  education  exacted  of  medical  stu- 
dents throughout  the  United  States,  but  that  there 
is  no  general  rule  adopted  in  any  particular  state 
or  district,  which  has  been  authorized  or  recom- 
mended by  medical  societies  or  other  official 
bodies,  or  established  by  common  consent  or 
custom.  The  whole  subject  is  left  to  private 
preceptors,  many  of  whom  recommend,  and  a 
few  exact,  an  elevated  standard,  while  others 
leave  it  to  the  discretion  of  the  students  them- 
selves, or  their  parents."  Hence,  the  standard 
recommended  by  the  committee,  and  adopted  by 
the  convention,  although  not  all  that  we  could 
desire,  is  perhaps  as  high  as  it  would  be  judicious 
to  insist  on  at  the  present  time  ;  and  from  it  we 
anticipate  the  happiest  results. 

The  committee  appointed  to  report  on  the  sub- 
ject of  a  uniform  and  elevated  standard  of  require- 
ments for  the  degree  of  M.D.,  of  whom  Dr.  Haxall, 
of  Richmond,  Virginia,  was  chairman,  also  pre- 
sented an  able  and  interesting  report,  whicfy 
closed  with  the  following  specific  recommenda- 
tions, viz. : — 

"Resolved,  1st,  That  it  be  recommended  to  all 
the  colleges  to  extend  the  period  employed  in 
lecturing  from  four  to  six  months. 


MEDICAL    HISTORY.  133 

"  2d,  That  no  student  shall  become  a  candidate 
for  the  degree  of  M.D.  unless  he  shall  have 
devoted  three  entire  years  to  the  study  of  medi- 
cine, including  the  time  allotted  to  attendance 
upon  the  lectures. 

"3d,  That  the  candidate  shall  have  attended  two 
full  courses  of  lectures,  that  he  shall  be  twenty- 
one  years  of  age,  and  in  all  cases  shall  produce 
the  certificate  of  his  preceptor,  to  prove  when  he 
commenced  his  studies. 

"  4th,  That  the  certificate  of  no  preceptor  shall 
be  received  who  is  avowedly  and  notoriously  an 
irregular  practitioner,  whether  he  shall  possess 
the  degree  of  M.D.  or  not. 

"  5lh,  That  the  several  branches  of  medical 
education  already  named  in  this  report  (theory 
and  practice  of  medicine,  principles  and  practice 
of  surgery,  general  and  special  anatomy,  physiolo- 
gy and  pathology,  materia  medica,  therapeutics 
and  pharmacy,  midwifery  and  diseases  of  women 
and  children,  chemistry  and  medical  jurisprudence) 
be  taught  in  all  the  colleges,  and  that  the  number 
of  professors  be  increased  to  seven. 

"  6th,  That  it  is  required  of  candidates  that  they 
shall  have  steadily  devoted  three  months  to  dis- 
sections. 

"  7th,  That  it  is  incumbent  upon  preceptors  to 
avail  themselves  of  every  opportunity  to  impart 


134  MEDICAL    HISTORY. 

clinical  instruction  to  their  pupils,  and  upon  medi- 
cal colleges  to  require  candidates  for  graduation 
to  show  that  they  have  attended  on  hospital  prac- 
tice for  one  session,  whenever  it  can  be  accom- 
plished, for  the  advancement  of  the  same  end. 

"  8th,  That  it  be  suggested  to  the  faculties  of 
the  various  medical  institutions  of  the  country  to 
adopt  some  efficient  means  for  ascertaining  that 
their  students  are  actually  in  attendance  upon 
their  lectures. 

"  9th,  That  it  is  incumbent  on  all  schools  and 
colleges  granting  diplomas,  fully  to  carry  out  the 
above  requisitions. 

"  10th,  That  it  be  considered  the  duty  of  pre- 
ceptors to  advise  their  students  to  attend  only 
such  institutions  as  shall  rigidly  adhere  to  the 
recommendations  herein  contained." 

After  some  discussion,  during  which  consider- 
able opposition  was  manifested  to  the  clause 
extending  the  term  of  lecturing  in  the  colleges  to 
six  months,  all  these  requisitions  were  adopted  by 
a  large  majority.  How  far  they  will  be  complied 
with  on  the  part  of  the  schools  remains  to  be 
seen.  It  is  worthy  of  remark,  however,  that  the 
movement  has  received  the  full  sanction  of  two 
of  the  oldest  and  most  influential  schools  in  the 
country,  viz.,  the  University  of  Pennsylvania,  and 
the  College  of  Physicians  and  Surgeons  in  New 


MEDICAL    HISTORY.  135 

York.  Both  these  colleges  have  added  more  than 
one  month  to  their  regular  term,  besides  a  pre- 
liminary course,  extending  the  whole  beyond  the 
six  months  required  by  the  convention.  The  in- 
fluence of  the  recommendation  is  still  farther 
perceptible  in  the  fact,  that  most  of  the  colleges 
which  have  not  extended  their  regular  term, 
have  at  least  added  a  preliminary  course  of  one 
month,  and  several  of  them  an  additional  profes- 
sorship ;  and  there  is  no  doubt  but  a  steady  ad- 
herence, on  the  part  of  the  American  Medical 
Association,  to  the  standard  adopted  by  the  con- 
vention, will  speedily  insure  its  entire  practical 
adoption  by  the  schools.  Indeed,  we  are  satisfied 
that  a  very  large  majority  of  the  colleges  would 
have  yielded  to  so  reasonable  and  necessary  a 
measure  as  the  extension  of  the  regular  college 
term  to  six  months  at  once,  if  each  had  not  feared 
that  its  neighbours  and  rivals  would  not.  And 
Oiis  again  strongly  illustrates  the  importance  of  a 
national  organization,  in  procuring  connected  and 
efficient  action  on  subjects  affecting  the  interests 
of  the  whole  profession.  Another  important 
resolution  adopted  by  the  first  convention  was  as 
follows,  viz.: — 

"  Resolved,  That  it  is  expedient  that  the  medi- 
cal profession  in  the  United  States  should  be 
governed  by  the  same  medical  ethics,  and  that  a 


136  MEDICAL    HISTORY. 

committee  of  seven  be  appointed  to  report  a  code 
for  that  purpose,  at  a  meeting  to  be  held  at  Phila- 
delphia, on  the  first  Wednesday  of  May,  1847." 

The  committee  appointed  under  this  resolution 
consisted  of  Drs.  John  Bell,  Isaac  Hays,  and  G. 
Emerson  of  Philadelphia;  Dr.  W.  W.  Morris,  of 
Delaware ;  T.  C.  Dunn,  of  Rhode  Island ;  A. 
Clark,  of  New  York ;  and  R.  D.  Arnold,  of 
Georgia.  At  the  ensuing  convention  in  Phila- 
delphia Dr.  Bell,  chairman  of  the  committee,  made 
an  able  report,  which  was  unanimously  adopted 
by  the  convention.  This  report,  from  its  intrinsic 
importance,  its  general  adoption  by  the  profession, 
and  the  consequent  index  which  it  presents  of  the 
present  tone  of  moral  feeling  among  medical  men, 
would  legitimately  constitute  a  part  of  oiir  history. 
But  its  length  is  such  that  we  must  be  content 
with  a  few  extracts,  which  will  indicate  the 
character  of  the  whole  : — 

"  Medical  ethics."  says  the  introduction  to  the 
code,  "  as  a  branch  of  general  ethics,  must  rest  on 
the  basis  of  morality  and  religion.  They  com- 
prise not  only  the  duties,  but  also  the  rights  of  a 
physician,  and,  in  this  sense,  they  are  identical 
with  medical  deontology — a  term  introduced  by 
a  late  writer,  who  has  taken  the  most  comprehen- 
sive view  of  the  subject." 

Again,  in  speaking  of  the  duties  of  the  physi- 


MEDICAL    HISTORY.  137 

cian  to  his  patients,  the  committee  says — "a  phy- 
sician should  not  only  be  ever  ready  to  obey  the 
calls  of  the  sick,  but  his  mind  ought,  also,  to  be  im- 
bued with  the  greatness  of  his  mission,  and  the 
responsibility  he  habitually  incurs  in  its  discharge. 
Those  obligations  are  the  more  deep  and  endur- 
ing, because  there  is  no  tribunal  other  than  his 
own  conscience,  to  adjudge  penalties  for  careless- 
ness or  neglect.  Physicians  should,  therefore, 
minister  to  the  sick  with  due  impressions  of  the 
importance  of  their  office,  reflecting  that  the  ease, 
the  health,  and  the  lives  of  those  committed  to 
their  charge,  depend  on  their  skill,  attention,  and 
fidelity.  They  should  study,  also,  in  their  deport- 
ment, so  to  unite  tenderness  with  firmness,  and 
condescension  with  authority,  as  to  inspire  the 
minds  of  their  patients  with  gratitude,  respect,  and 
confidence." 

And,  again,  "  there  is  no  profession,  from  the 
members  of  which  greater  purity  of  character, 
and  a  higher  standard  of  moral  excellence,  are  re- 
quired, than  the  medical ;  and  to  attain  such 
eminence  is  a  duty  every  physician  owes,  alike  to 
his  profession  and  to  his  patients.  It  is  due  to 
the  latter,  as  without  it  he  cannot  command  their 
respect  and  confidence,  and  to  both,  because  no 
scientific  attainments  can  compensate  for  the  want 
of  correct  moral  principles.  It  is  also  incumbent 


138  MEDICAL    HISTORY. 

upon  the  faculty  to  be  temperate  in  all  .things,  for 
the  pi-actice  of  physic  requires  the  unremitting 
exercise  of  a  clear  and  vigorous  understanding ; 
and,  on  emergencies,  for  which  no  professional 
man  should  be  unprepared,  a  steady  hand,  an 
acute  eye,  and  an  unclouded  head,  may  be  essen- 
tial to  the  well-being,  and  even  to  the  life,  of  a 
fellow  creature." 

The  same  liberal  and  enlightened  sentiments 
pervade  the  whole  report,  and  its  general  adoption 
bespeaks  a  commendable  tone  of  moral  feeling 
throughout  the  profession.  Able  reports  were  also 
made  to  the  Philadelphia  Convention  on  the  sub- 
ject of  "  a  Registration  of  the  Births,  Marriages, 
and  Deaths  occurring  in  the  populations  of  the 
several  States,"  and  on  "  a  Nomenclature  of  Dis- 
eases adapted  to  the  United  States,  having  refe- 
rence to  a  general  registration  of  deaths."  These 
reports,  together  with  the  nomenclature  recom- 
mended by  the  committee,  and  adopted  by  the 
convention,  may  be  found  in  the  published  "  Pro- 
ceedings of  the  National  Medical  Conventions, 
held  in  May  184G,  and  1847." 

At  the  convention  in  New  York,  the  following 
resolution  was  presented,  and,  after  some  discus- 
sion, was  referred  to  a  committee  of  seven,  with 
instructions  to  report  at  the  next  convention  in 
Philadelphia  : — "Resolved,  That  the  union  of  the 


MEDICAL    HISTORY.  139 

business  of  teaching  and  licensing  in  the  same 
hands,  is  wrong  in  principle,  and  liable  to  great 
abuse  in  practice.  Instead  of  conferring  the  right 
to  license  on  medical  colleges,  and  state  and 
county  medical  societies,  it  should  be  restricted 
to  one  board  in  each  state,  composed  in  fair  pro- 
portion of  representatives  from  its  medical  col- 
leges, and  the  profession  at  large,  and  the  pay  for 
whose  services,  as  examiners,  should,  in  no  degree, 
depend  on  the  number  licensed  by  them."  The 
committee  consisted  of  Drs.  James  M'Naughton, 
of  Albany,  N.Y. ;  J.  R.  Manly,  and  J.  W.  Fran- 
cis, N.Y. ;  Isaac  Parrish,  Philadelphia ;  R.  Blake- 
man,  Fairfield,  Conn. ;  J.  Cullen,  Richmond, 
Virginia ;  and  Thomas  Cock,  N.Y. 

At  the  succeeding  convention  in  Philadelphia, 
two  reports  were  presented  from  this  committee, 
a  minority  report  by  Dr.  M'Naughton,  the  chair- 
man, which,  though  in  its  general  tenor  opposed 
to  the  sentiments  contained  in  the  resolution,  yet 
yielded  something,  as  will  be  seen  by  the  follow- 
ing resolutions  appended  to  the  report,  viz.  : — 
"Resolved,  That  inasmuch  as  an  opinion  prevails 
to  a  considerable  extent  in  the  profession,  that 
certain  abuses  have  crept  into  some  of  the  col- 
leges— namely,  that  they  confer  degrees  upon 
persons  who  have  not  fully  complied  with  their 
own  requirements,  or  on  those  who  do  not  possess 


140  MEDICAL    HISTORY. 

the  requisite  amount  of  knowledge  to  entitle  them 
to  such  distinction,  it  is  deemed  expedient  by  this 
convention,  in  order  to  satisfy  the  just  wishes  of 
the  profession,  and  to  remove  just  grounds  of 
complaint,  that  such  colleges  as  do  not  already 
possess  mixed  boards  of  examiners,  should  consent 
to  have  associated  with  them,  in  the  examination 
for  degrees,  some  members  of  the  profession  not 
engaged  in  teaching,  or  otherwise  interested  in 
such  institutions. 

"  Resolved,  That  the  number  of  boards  for 
granting  licenses  in  the  several  states,  should  be 
as  limited  as  would  comport  with  the  convenience 
of  examiners  and  candidates  in  each  state." 

This  report  was  signed  by  only  two  members 
of  the  committee.  The  majority  report  was 
made  by  Dr.  Isaac  Fairish,  and  signed  also  by 
Drs.  J.  R.  Manly,  Thomas  Cock,  and  J.  W. 
Francis.'  It  presents,  in  clear  and  forcible  lan- 
guage, not  only  the  liability  to,  but  the  actual  ex- 
istence of,  abuses  in  the  granting  of  diplomas,  and 
the  right  of  the  profession  to  apply  some  appro- 
priate remedy.  Without,  however,  specifying  in 
what  an  appropriate  remedy  would  consist,  the  re- 
port concludes  with  the  following  preamble  and 
resolution,  viz.  : — "  Whereas,  a  general  sentiment 
prevails  in  the  medical  profession,  that  the  active 
competition  existing  among  the  medical  colleges 


MEDICAL    HISTORY.  141 

of  the  Union,  has  a  tendency  to  lower  the  stand- 
ard of  professional  requirement,  and  to  depreciate 
the  value  of  the  degree  ; 

"  And,  whereas,  the  facility  with  which  char- 
ters for  medical  corporations  are  obtained  from 
our  state  governments,  exposes  the  medical  pro- 
fession to  the  continuance  and  increase  of  such 
abuses,  inasmuch  as  these  corporations  possess 
alike  the  power  of  granting  the  license  to  prac- 
tice ;  therefore, 

"  Resolved,  That  in  the  opinion  of  this  conven- 
tion, some  additional  checks  to  the  exercise  of 
this  right  should  be  established  by  the  great  body 
of  the  medical  profession.." 

This  whole  subject  was  finally  disposed  of,  by 
adopting  the  following  resolution,  viz. : — "  RQ- 
solvsd,  That  in  view  of  the  necessity  hereby  de- 
clared for  reform,  in  the  manner  of  conferring 
degrees,  the  two  reports  submitted  by  the  com- 
mittee, on  the  separation  of  teaching  and  licens- 
ing, be  published  and  referred  to  the  committee 
on  medical  education,  with  instructions  to  report 
at  the  next  annual  meeting  of  the  American  Me- 
dical Association." 

But,  perhaps,  the  most  important  part  of  the 
proceedings  of  this  convention  remain  to  be  re- 
ferred to — namely,  the  formation  of  a  permanent 
national  association.  Among  the  resolutions 


142  MEDICAL    HISTORY. 

adopted  by  the  first  convention,  were  the  follow- 
ing, viz. : — "  Resolved,  That  it  is  expedient  for 
the  medical  profession  of  the  United  States,  to 
institute  a  national  medical  association  for  the 
protection  of  their  interests,  for  the  maintenance 
of  their  honor  and  respectability,  for  the  advance- 
ment of  their  knowledge,  and  the  extension  of 
their  usefulness. 

"  Resolved,  That  a  committee  of  seven  be  ap- 
pointed to  report  a  plan  of  organization  for  such 
an  association,  at  a  meeting  to  be  held  in  Phila- 
delphia, on  the  first  Wednesday  in  May,  1847." 

The  committee  appointed  in  accordance  with 
this  last  resolution,  consisted  of  Drs.  John  Wat- 
son, John  Stearns,  F.  Campbell  Stewart,  New 
York  ;  A.  Stille,  Philadelphia  ;  N.  S.  Davis,  Bing- 
hamton,  N.Y. ;  W.  H.  Cogswell,  New  London, 
Connecticut ;  E.  D.  Fremer,  New  Orleans. 

At  the  second  convention,  the  chairman  of  the 
committee,  Dr.  J.  Watson,  presented  the  follow- 
ing report,  which  was  adopted,  and  signed  by 
nearly  all  the  members  of  the  convention  : — 
"  Whereas,  The  medical  convention,  held  in  the 
city  of  New  York,  in  May,  1846,  have  declared 
it  expedient  '  for  the  medical  profession  of  the 
United  States  to  institute  a  national  medical  as- 
sociation ;'  and,  inasmuch  as  an  institution  so 
conducted  as  to  give  frequent,  united,  and  emphatic 


MEDICAL    HISTORY.  143 

expression  to  the  views  and  aims  of  the  medical 
profession  in  this  country,  must,  at  all  times,  have 
a  beneficial  influence,  and  supply  more  efficient 
means  than  have  hitherto  been  made  available 
here,  for  cultivating  and  advancing  medical  know- 
ledge, for  elevating  the  standard  of  medical  edu- 
cation, for  promoting  the  usefulness,  honor,  and 
interests  of  the  medical  profession,  for  enlighten- 
ing and  directing  public  opinion  in  regard  to  the 
duties,  responsibilities,  and  requirements  of  medi- 
cal men,  for  exciting  and  encouraging  emulation 
and  concert  of  action  in  the  profession,  and  for 
facilitating  and  fostering  friendly  intercourse  be- 
tween those  engaged  in  it ;  therefore,  be  it  re- 
solved, in  behalf  of  the  medical  profession  of  the 
United  States,  that  the  members  of 'the  medical 
convention  held  in  Philadelphia,  in  May,  1847, 
and  all  others  who,  in  pursuit  of  the  objects  above 
mentioned,  are  to  unite  with,  or  succeed  them, 
constitute  a  national  medical  association,  and  that 
for  the  organization  and  management  of  the  same, 
they  adopt  the  following  regulations  :— 

"  I.  TITLE  OP  THE  ASSOCIATION. — This  institu- 
tion shall  be  known  and  distinguished  by  the  name 
and  title  of  '  the  American  Medical  Association.' 

"  II.  MEMBERS. — The  members  of  this  institu- 
tion shall  collectively  represent,  and  have  cogniz- 
ance of,  the  common  interests  of  the  medical  pro- 


144  MEDICAL    HISTORY. 

fession  in  every  part  of  the  United  States,  and 
shall  hold  their  appointment  to  membership  either 
as  delegate's  from  local  institutions,  as  members 
by  invitation,  or  as  permanent  members.  The 
delegates  shall  receive  their  appointment  from 
permanently  organized  medical  institutions  of 
good  standing  in  the  United  States.  Each 
delegate  shall  hold  his  appointment  for  one 
year,  and  until  another  is  appointed  to  suc- 
ceed him,  and  shall  participate  in  all  the  busi- 
ness and  affairs  of  the  association.  Each  local 
society  shall  have  the  privilege  of  sending  to  the 
association  one  delegate  for  every  ten  of  its 
regular  resident  members,  and  one  for  every  ad- 
ditional fraction  of  more  than  half  that  number. 
The  faculty  of  every  regularly  constituted  medi- 
cal college  or  chartered  school  of  medicine,  shall 
have  the  privilege  of  sending  two  delegates.  The 
professional  staff  of  every  chartered  or  municipal 
hospital  containing  one  hundred  inmates  or  more, 
shall  have  the  privilege  of  sending  two  delegates ; 
and  every  other  permanently  organized  medical 
institution  of  good  standing  shall  have  the  privi- 
lege of  sending  one  delegate. 

"  The  Members  by  Invitation  shall  consist  of 
practitioners  of  respectable  standing,  from  sec- 
tions of 'the  United  States  not  otherwise  repre- 
sented at  the  meeting.  They  shall  receive  their 


MEDICAL    HISTORY.  145 

appointment  by  invitation  of  the  meeting,  after  an 
introduction  from  any  of  the  members  present,  or 
from  any  of  the  absent  permanent  members. 
They  shall  hold  their  connection  with  the  associa- 
tion until  the  close  of  the  annual  session  at  which 
they  are  received,  and  shall  be  entitled  to  partici- 
pate in  all  its  affairs,  as  in  the  case  of  delegates. 

"  The  Permanent  Members  shall  consist  of  all 
those  who  have  served  in  the  capacity  of  dele- 
gates, and  of  such  other  members  as  may  receive 
the  appointment  by  unanimous  vote.  Permanent 
members  "  shall,  at  all  times,  be  entitled  to  attend 
the  meetings,  and  participate  in  the  affairs  of  the 
association,  so  long  as  they  shall  continue  to  con- 
form to  its  regulations,  but  without  the  right  of 
voting ;  and,  when  not  in  attendance,  they  shall 
be  authorized  to  grant  letters  of  introduction  to 
reputable  practitioners  of  medicine  residing  in  their 
vicinity,  who  may  wish  to  participate  in  the  busi- 
ness of  the  meetings  as  provided  for  the  members 
by  invitation.  Every  member  elect,  prior  to  the 
permanent  organization  of  the  annual  meeting,  or 
before  voting  on  any  question  after  the  meeting 
has  been  organized,  must  sign  these  regulations, 
inscribing  his  name  and  address  in  full,  specifying 
in  what  capacity  he  attends,  and,  if  a  delegate, 
the  title  of  the  institution  from  which  he  has  re- 
ceived his  appointment. 


146  MEDICAL    HISTORY. 

S 

"  III.  MEETINGS. — The  regular  meetings  of  the 
association  shall  be  held  annually,  and  commence 
on  the  first  Tuesday  in  May.  The  place  of  meet- 
ing shall  never  be  the  same  for  any  two  years  in 
succession,  and  shall  be  determined  for  each  next 
succeeding  year  by  vote  of  the  association. 

"  IV.  OFFICERS. — The  officers  of  the  association 
shall  be  a  president,  four  vice-presidents,  two  se- 
cretaries, and  a  treasurer.  They  shall  be  nomi- 
nated by  a  special  committee  of  one  member  from 
each  state  represented  at  the  meeting,  and  shall 
be  elected  by  vote  on  a  general  ticket.  Each 
officer  shall  hold  his  appointment  for  one  year, 
and  until  another  is  elected  to  succeed  him. 

"  The  President  shall  preside  at  the  meetings, 
preserve  order  and  decorum  in  debate,  give  a 
casting  vote  when  necessary,  and  perform  all  the 
other  duties  that  custom  and  parliamentary  usage 
may  require. 

"  The  Vice-P residents,  when  called  upon,  shall 
assist  the  president  in  the  performance  of  his 
duties,  and,  during  the  absence,  or  at  the  request 
of  the  president,  one  of  them  shall  officiate  in  his 
place. 

"  The  Secretaries  shall  recoKl  the  minutes,  and 
authenticate  the  proceedings,  give  due  notice  of 
the  time  and  place  of  each  next  ensuing  meeting, 
and  serve  as  members  of  the  committee  on  publi- 


MEDICAL    HISTORY.  147 

cation.  The  secretary  first  in  nomination  shall 
also  preserve  the  archives  and  unpublished  trans- 
actions of  the  association. 

"  The  Treasurer  shall  have  the  immediate 
charge  and  management  of  the  funds  and  pro- 
perty of  the  association.  He  shall  be  a  member 
of  the  committee  on  publication,  to  which  com- 
mittee he  shall  give  bonds  for  the  safe  keeping, 
and  proper  use,  and  disposal  of  his  trust;  and 

• 

through  the  same  committee  he  shall  present  his 
accounts,  duly  authenticated,  at  every  regular 
meeting. 

• 

"  V.  STANDING  COMMITTEES.- — The  following 
standing  committees,  each  composed  of  seven 
members,  shall  be  organized  at  every  annual 
meeting,  for  preparing,  arranging,  and  expediting 
business  for  each  next  ensuing  year,  and  for  car- 
rying into  effect  the  orders  of  the  association  not 
otherwise  assigned — namely,  a  committee  on  ar- 
rangements, a  committee  on  medical  sciences,  a 
committee  on  practical  medicine,  a  committee  on 
surgery,  a  committee  on  obstetrics,  a  committee 
on  medical  education,  a  committee  on  medical 
literature,  and  a  committee  on  publication. 

"  The  Committee  on  Arrangements  shall,  if  no 
sufficient  reasons  prevent,  be  mainly  composed  of 
members  residing  in  the  place  at  which  the  asso- 
ciation is  to  hold  its  next  annual  meeting,  and 


148  MEDICAL    HISTORY. 

shall  be  required  to  provide  suitable  accommoda- 
tions for  the  meeting,  to  verify  and  report  on  the 
credentials  of  membership,  to  receive  and  an- 
nounce all  essays  and  memoirs  voluntarily  com- 
municated, either  by  members  of  the  association, 
or  by  others  through  them,  and  to  determine  the 
order  in  which  such  papers  shall  be  read  and  con- 
sidered. 

"  The  Committee'  on  Medical  Sciences  shall 
prepare  an  annual  report  on  the  progress  of  medi- 
cal sciences  in  America,  noticing,  as  occasion 
may  require,  the  important  improvements  and 
discoveries  in  anatomy,  physiology,  hygiene,  gene- 
ral pathology  and  therapeutics,  medical  jurispru- 
dence, materia  medica,  and  other  branches  of 
natural  science,  bearing  directly  on  the  condition 
and  progress  of  medical  knowledge  in  America, 
during  the  year  of  their  service. 

"  The  Committee  on  Practical  Medicine  shall 
prepare  an  annual  report  on  the  more  important 
improvements  effected  in  this  country,  in  the 
management  of  individual  diseases,  and  on  the 
progress  of  epidemics,  referring,  as  occasion  re- 
quires, to  medical  topography,  and  to  the  charac- 
ter of  prevailing  diseases  in  special  localities,  or 
in  the  United  States  generally,  during  the  term  of 
their  service. 

"  The  Committee  on  Surgery  shall  prepare  an 


MEDICAL    HISTORY.  149 

annual  report  on  all  the  important  improvements 
in  the  management  of  surgical  diseases  effected  in 
America  during  the  year. 

"  The  Committee  on  Obstetrics  shall  prepare  an 
annual  report  on  all  the  improvements  in  the  ob- 
stetric art,  and  in  the  management  of  diseases 
peculiar  to  women  and  children,  effected  in 
America  during  the  year, 

"  The  Committee  on  Medical  Education  shall 
prepare  an  annual  report  on  the  general  condition 
of  medical  education  in  the  United  States,  in  com- 
parison with  the  state  of  medical  education  in 
other  enlightened  nations ;  noticing,  as  occasion 
may  call  for,  the  courses  of  instruction,  the  prac- 
tical requirements  for  graduation,  the  modes  of 
examination  for  conferring  degrees,  and  the  re- 
puted number  of  pupils  and  graduates  at  the  seve- 
ral medical  institutions  in  the  United  States,  dur- 
ing the  year  ;  noticing,  also,  the  requirements  of 
the  United  States  army  and  navy  boards  of  medi- 
cal examiners,  the  legal  requirements  exacted  of 
medical  practitioners  in  our  several  states,  and  all 
such  measures,  prospective  or  established,  in  re- 
ference to  medical  education  and  the  reputable 
standing  of  the  profession,  as  may  be  deemed 
worthy  of  special  consideration. 

The  Committee  on  Medical  Literature  shall 
prepare  an  annual  report  on  the  general  character 


150  MEDICAL    HISTORY. 

of  the  periodical  medical  publications  of  the 
United  States,  in  reference  to  the  more  important 
articles  therein  presented  to  the  profession,  on 
original  medical  publications,  on  medical  compila- 
tions and  compends  of  American  writers,  on 
American  reprints  of  foreign  works,  and  on  all 
such  measures  as  maybe  deemed  advisable  for 
encouraging  and  maintaining  a  national  literature 
of  our  own. 

"  The  Committee  on  Publication,  of  which  the 
secretaries  and  treasurer  must  constitute  a  part, 
shall  have  charge  of  preparing  for  the  press,  and 
of  publishing  and  distributing  such  of  the  proceed- 
ings, transactions,  and  memoirs  of  the  association, 

• 

as  may  be  ordered  to  be  published. 

"  The  six  members  of  the  committee  who  have 
not  the  immediate  management  of  the  funds,  shall, 
also,  in  their  own  names,  as  agents  of  the  associa- 
tion, hold  the  bond  of  the  treasurer  for  the  faith- 
ful execution  of  his  office,  and  shall  annually  audit 
and  authenticate  his  accounts,  and  present  a  state- 
ment of  the  same  in  the  annual  report  of  the  com- 
mittee, which  report  shall  also  specify  the  charac- 
ter and  cost  of  the  publications  of  the  association 
during  the  year,  the  number  of  copies  still  at  the 
disposal  of  the  meeting,  the  funds  on  hand  for 
further  operations,  and  the  probable  amount  of 
the  assessment  to  be  laid  on  each  member  of 


MEDICAL    HISTORY.  151 

the  association,  for  covering  its  annual   expen- 
diture. 

"  VI.  FUNDS  AND  APPROPRIATIONS. — Funds 
shall  be  raised  by  the  association  for  meeting  its 
current  expenses  and  awards  from  year  to  year ; 
but  never  with  a  view  of  creating  a  permanent 
income  from  investments.  Funds  may  be  ob- 
tained by  an  equal  assessment  of  not  more  than 
three  dollars  annually  on  each  of  the  members, 
by  individual  voluntary  contributions  for  specific 
objects,  and  by  the  sale  and  disposal  of  publica- 
tions, or  of  works  prepared  for  publication.  The 
funds  may  be  appropriated  for  defraying  the 
expenses  of  the  annual  meetings  ;  for  publishing 
the  proceedings,  memoirs,  and  transactions  of  the 
association  ;  for  enabling  the  standing  committees 
to  fulfill  their  respective  duties,  conduct  their 
correspondence,  and  procure  the  materials  neces- 
sary for  the  completion  of  their  stated  annual 
reports ;  for  the  encouragement  of  scientific  in- 
vestigations, by  prizes  and  awards  of  merit ;  and 
for  defraying  the  expenses  incidental  to  specific 
investigations,  under  the  instructions  of  the  asso- 
ciation, where  such  investigations  have  been 
accompanied  with  an  order  on  the  treasurer  to 
supply  the  funds  necessary  for  carrying  them  into 
effect. 
"VII.  PROVISION  FOR  AMENDMENTS. — No  amend- 


152  MEDICAL    HISTORY. 

ments  or  alterations  shall  be  made  in  any  of  these 
articles  except  at  the  annual  meeting  next  subse- 
quent to  that  at  which  such  amendment  or  altera- 
tion may  have  been  proposed ;  and  then  only  by 
the  voice  of  three-fourths  of  all  the  members  in 
attendance.  Atid  in  acknowledgment  of  having 
adopted  the  foregoing  propositions,  and  of  our 
willingness  to  abide  by  them,  and  use  our  endea- 
vours to  carry  into  effect  the  objects  of  this  asso- 
ciation as  above  set  forth,  we  have  hereunto 
affixed  our  names." 

Such  is  the  plan  of  organization  adopted,  and 
finally  carried  into  effect  on  the  7th  of  May,  1847, 
by  the  election  of  the  following  officers,  viz. : — 
Dr.  Nathaniel  Chapman,  of  Pennsylvania,  presi- 
dent ;  Drs.  Jonathan  Knight,  Connecticut,  Alex. 
H.  Stevens,  New  York,  James  Moultire,  South 
Carolina,  A.  H.  Buchanan,  Tennessee,  vice-presi- 
dents ;  Drs.  Alfred  Stille,  Philadelphia,  J.  R.  W. 
Dunbar,  Baltimore,  secretaries ;  and  Dr.  Isaac 
Hays,  Philadelphia,  treasurer. 

The  several  committees  required  by  the  consti- 
tution were  also  appointed,  and,  in  addition,  a 
committee  of  one  from  each  state  represented  in 
the  association  to  report,  in  obedience  to  the 
following  resolution,  which  I  had  the  honor  to 
present  to  the  association,  viz. : — Resolved,  That 


MEDICAL,    HISTORY.  153 

a  committee  of  one  from  each  state  represented 
in  this  convention  be  appointed  by  the  president, 
whose  duty  it  shall  be  to  investigate  the  indigenous 
medical  botany  of  our  country,  paying  particular 
attention  to  such  plants  as  are  now,  or  may  be 
hereafter  during  the  term  of  their  service,  found 
to  possess  valuable  medicinal  properties,  and  are 
not  already  accurately  described  in  the  standard 
works  of  our  country ;  and  report  the  same  in 
writing,  giving  not  only  the  botanical  and  medical 
description  of  each,  but  also  the  localities  where 
they  may  be  found,  to  the  next  annual  meeting  of 
the  American  Medical  Association."  On  a  motion 
made  by  Dr.  John  B.  Johnson,  of  Missouri,  the 
committee  on  medical  education  were  instructed 
to  "  inquire  into  the  expediency  of  establishing  a 
school  or  schools  of  pharmacy  in  the  respective 
states,  for  the  special  purpose  of  preparing  persons 
for  the  business  of  apothecaries ;  and  also  the 
expediency  of  adopting  a  rule  that  no  physician 
ought  to  patronize  a  druggist  or  apothecary  who 
deals  in  patent  and  secret  medicines ;  and  report 
at  the  next  annual  meeting  of  the  association." 
The  reader  will  now  see,  from  the  foregoing  liberal 
extracts  from  the  proceedings  of  the  two  conven- 
tions, that  we,  not  only  have  an  American  Medical 
Association,  truly  national  in  its  character,  em- 
bracing, as  it  does,  every  interest  fairly  within  the 
7* 


154  MEDICAL    HISTORY. 

profession,  organized  on  a  sound  and  liberal  basis  , 
but  also  that  such  association  has  entered  upon 
the  work  of  cultivating  medical  science,  fostering 
our  own  medical  literature,  and  elevating  the 
medical  character,  with  a  unanimity  and  zeal 
honorable  alike  to  its  founders  and  to  the  whole 
profession  of  our  country.  For  proof  of  this,  we 
need  only  refer  to  its  annual  volume  of  transac- 
tions, embodying  a  series  of  reports,  and  papers 
of  great  interest  and  value, — reports  and  papers, 
indeed,  which  should  be  in  the  hands  of  every 
physician  throughout  the  country.  The  annual 
meetings  of  the  association  have  steadily  increased 
both  in  interest  and  in  the  number  of  delegates  in 
attendance.  The  interest  developed  by  the 
organization  and  successful  carrying  on  of  the 
American  Medical  Association,  has  extended 
itself  until  it  involves  the  profession  of  the  whole 
Union ;  and,  besides  the  results  already  detailed, 
it  has  led  to  the  re- animation  and  activity  of  old 
societies  and  associations — to  the  formation  of 
new  ones  where  none  existed  before — to  a  more 
free  and  liberal  intercourse  among  medical  men — 
and  to  a  more  lively  and  universal  sense  of  the 
high  aims,  interests,  and  responsibilities  of  the 
profession. 

Hence,  notwithstanding  the  abolishment  of  all 
laws  regulating  the  practice  of  medicine  in   so 


MEDICAL    HISTORY.  155 

large  a  number  of  states,  and  the  consequent 
absence  of  all  legal  protection,  the  profession  was, 
probably,  never  making  more  rapid  advancement 
in  its  education,  its  science  and  literature,  and  its 
social  position,  than  at  the  present  time.  Yet,  as 
we  shall  see  in  the  subsequent  chapter,  much 
remains  to  be  done.  In  the  two  preceding  chap- 
ters, we  have  given  a  brief  account  of  the  medical 
works  published,  a,nd  of  the  improvements  made 
during  each  period ;  but  even  a  simple  enumera- 
tion of  these,  during  the  last  forty  years,  would 
extend  the  limits  of  this  work  too  far,  and  contri- 
bute but  little  to  its  main  design. 

Yet  the  charge  has  been  so  often  made,  that 
the  prpiession  in  this  country  is  not  only  destitute 
of  a  literature  of  its  own,  but  its  records  also 
unadorned  by  any  important  discoveries  in  the 
various  departments  of  our  science,  that  we  can- 
not conclude  the  historical  part  of  this  work  with- 
out devoting  a  brief  space  to  this  interesting  topic. 
I  have  already  alluded  in  the  preceding  chapters 
to  such  important  improvements  as  were  made 
previous  to  1806,  and  hence  we  need  not  refer  to 
the  records  anterior  to  that  period.  So  early  as 
1809,  a  period  several  years  anterior  to  that  which 
ushered  in  the  brilliant  discoveries  of  Sir  Charles 
Bell,  in  relation  to  the  cerebro- spinal  nerves,  Dr. 
James  H.  Miller,  of  Baltimore,  commenced  a. 


156  MEDICAL    HISTOKY. 

series  of  experiments  and  observations  on  the? 
structure  and  functions  of  the  great  sympathetic 
or  organic  system  of  nerves,  from  which  he  was 
soon  enabled  to  deduce  those  conclusions  which 
have  been  since  generally  received  by  physiolo- 
gists, and  for  a  detailed  account  of  which  the 
reader  is  referred  to  Miller's  edition  of  Wilson 
Philip,  or  to  an  Essay  on  Discoveries  in  the 
Physiology  of  the  Nervous  System,  in  Transac- 
tions of  the  Medical  Society  of  the  State  of  New 
York,  vol.  5th,  page  21.  These  important  de- 
velopments in  relation  to  that  portion  of  the 
nervous  system  were  publicly  taught  by  Dr. 
Miller  in  the  Washington  Medical  College,  in 
1827,  two  or  three  years  previous  to  the  publica- 
tion of  M.  Brachet's  views  on  the  same  subject. 
If  we  add  to  the  discoveries  of  Dr.  Miller  the 
experiments  of  Dr.  Henry  H.  Smith,  of  Philadel- 
phia, in  reference  to  the  extent  of  the  respiratory 
tract  in  the  medulla  spinalis,  and  the  patient  and 
intensely  interesting  researches  of  Dr.  S.  G.  Mor- 
ton, as  embodied  in  his  work  entitled  Crania 
Americana,  and  the  still  more  recent  investigations 
of  Dr.  B.  Dowler,  of  New  Orleans,  we  shall  have 
claimed  for  our  countrymen  the  merit  of  origin- 
ality in  developing  an  important  share  of  our 
present  knowledge  concerning  the  physiology  of 
the  whole  nervous  structure.  If  we  add  to  these 


MliUICAL    HISTORY.  157 

the  highly  valuable  experiments  of  Dr.  Beaumont 
on  digestion — the  experiments  of  Dr.  J.  K. 
Mitchell,  of  Philadelphia,  on  the  absorption  of 
liquids  and  the  transmissibility  of  gases  through 
animal  tissues — those  of  Dr.  R.  E.  Rogers,  proving 
so  conclusively  the  existence  of  carbonic  acid  in 
veinous  blood,  and  the  facility  with  which  it 
penetrates  through  animal  tissues  whenever  ano- 
ther gas  is  brought  in  contact  with  the  opposite 
side  of  the  same  tissue,  and  thus  placing  at  rest 
the  long-disputed  question,  whether  the  carbonic 
acid  thrown  off  in  respiration  is  formed  by  the 
union  of  carbon  and  oxygen  in  the  lungs,  or  is 
brought  to  the  lungs  ready  formed  in  the  veinous 
blood — and  those  of  several  other  original  investi- 
gators of  scarcely  less  importance,  we  shall  readily 
perceive  that  our  countrymen  can  no  longer  be 
justly  reproached  with  having  made  no  positive 
additions  to  the  general  stock  of  knowledge  on 
the  subject  of  physiology. 

Acrain,  if  we  look  over  the  resources  of  the 

O  ' 

materia  medica,  we  shall  find  many  additions  to 
the  common  stock  of  the  very  first  importance, 
and  associated  therewith  a  list  of  names  whose 
lustre  is  scarcely  exceeded  by  those  of  any  other 
country.  Among  the  latter  may  be  named  the 
Bartons,  Bigelow,  Woods,  Eberle,  Chapman, 
Grifteth,  Gray,  Torry,  etc.,  etc. ;  while  belonging 


158  MEDICAL    HISTORY. 

to  the  former  are  the  Sangirnaria  Canadensis, 
Cimicifuga  Racemosa,  Rumex  Obtusifolium,  Ge- 
ranium Maculatum,  Erigerons,  Trilliums,  Prunus 
Virginiana  or  Cerasus,  Cornus  Florida,  Lobelia 
Inflata,  Lactucarium,  Spigelia  Marylandica,  Gil- 
lenia  Trifolia,  Juglans  Cinerea,  Podophyllum  Pel- 
tatum,  Secale  Cornutum,  and  many  others.  Here 
we  have  Vegetable  Alteratives,  Astringents, 
Tonics,  and  Febrifuges ;  Anodynes  and  Anthel- 
mintics  ;  Emetics  and  Cathartics  ;  of  equal  value 
with  any  foreign  articles  belonging  to  the  same 
classes.  And  if  we  add  to  these,  the  recent 
brilliant  application  of  elher  to  the  prevention  of 
pain  during  surgical  operations,  we  shall  see,  at  a 
glance,  that  the  profession  of  no  country  have 
made,  during  the  same  length  of  time,  more  nume- 
rous or  valuable  additions  to  our  resources  for 
combating  disease  and  alleviating  pain,  than  that 
of  our  own.  And  if  we  turn  from  these  to  ther- 
apeutics and  operative  surgery,  we  shall  find  our 
national  credit  still  better  sustained.  For  though 
we  can  boast  of  the  invention  of  no  great  hypo- 
theses or  systems,  which,  like  the  Brunonian,  Cul- 
lenian,  or  Broussaian,  have  swayed  the  minds  of 
a  large  portion  of  the  medical  world,  we  can 
claim  what  is  far  more  important  to  the  interests 
of  science,  viz.,  a  great  accumulation  of  facts 
bearing  on  almost  every  question  connected 


MEDICAL    HJSTORV.  159 

with  medical  and  surgical  pathology  and  prac- 
tice. 

The  medical  literature  of  no  country,  furnishes 
the  materials  for  settling  more  satisfactorily,  the 
endemic  or  non-contagious  character  of  yellow 
fever,  as  well  as  all  the  forms  of  bilious  remittents 
and  intermittents,  while  the  labors  of  Drs.  Ger- 
hard, Pennock,  Stewardson,  James  Jackson,  and 
Hale,  afford  some  of  the  best  contributions  ex- 
tant, concerning  the  pathology,  anatomical  lesions, 
and  treatment  of  the  two  great  forms  of  continued 
fever.  One  of  the  earliest,  and,  therefore,  most 
important  diagnostic  signs  of  pulmonary  tubercles, 
viz.,  the  prolonged  bronchial  expiration,  was 
first  pointed  out  by  the  late  and  accomplished  Dr. 
James  Jackson,  Jr.,  while  our  knowledge  of  other 
forms  of  pulmonary  disease  has  been  much  im- 
proved by  the  investigations  of  Drs.  Morton, 
Gerhard,  Clark,  Camman,  Bowditch,  and  others.  < 

In  practical  surgery,  the  important  operations 
first  devised  and  performed  by  American  surgeons 
are,  the  application  of  anaplasty  to  the  relief  of 
cicatrices  and  deformities  produced  by  burns,  by 
Dr.  Mutter ;  the  formation  of  an  artificial  penis, 
by  Dr.  Mettauer,  of  Virginia ;  and  still  other  im- 
provements in  the  same  department  by  Drs.  Mott, 
J.  K.  Rogers,  A.  C.  Post,  of  New  York ;  and  J. 
M.  Warren,  of  Boston  ;  the  exsection  of  the  lower 


160  MEDICAL    HISTORY. 

jaw  for  osteo-sarcoma,  by  Dr.  Mott ;  tying  the 
right  subclavian  artery  without  the  scaleni  muscles, 
by  Dr.  Wright  Post ;  tying  the  left  subclavian 
within  the  scaleni  muscles,  by  Dr.  J.  K.  Rogers ; 
tying  of  the  arteria  innominata,  and  primitive 
illiac,  by  Dr.  V.  Mott ;  division  of  the  masseter 
muscle  for  immobility  of  the  lower  jaw,  by  Dr.  J. 
M.  Carnochan ;  the  formation  of  artificial  joints 
by  excision  of  a  portion  of  bone,  by  J.  Rhea  Bar- 
ton ;  exsection  of  the  knee  joint  to  remove  de- 
formity occasioned  by  anchylosis,  by  Dr.  G.  Buck ; 
the  effectual  separation  of  web  fingers  and  toes, 
by  Dr.  J.  K.  Rogers  ;  tying  of  both  corotids  within 
a  few  days  of  each  other,  by  Dr.  R.  D.  Mussey, 
of  Cincinnati ;  the  introduction  of  setons  for  the 
cure  of  artificial  joints,  by  Dr.  P.  S.  Physick ; 
the  cure  of  aneurism  by  anastimosis,  by  the  appli- 
cation of  hot  needles,  by  Dr.  G.  S.  Patterson ; 
successful  operation  for  the  removal  of  introsus- 
ception,  by  J.  R.  Wilson,  of  Mississippi;  and 
many  others,  by  such  men  as  A.  H.  Stevens, 
Physick,  Dorsy,  Parrish,  Pancoast,  White,  etc., 
etc. 

The  profession  in  no  country  is,  probably,  more 
purely  eclectic  in  its  character  than  our  own. 
Deprived,  in  a  great  measure,  of  the  accumulated 
wealth  of  many  of  the  countries  on  the  other  side 
of  the  Atlantic,  but  few  members  of  the  profession 


MEDICAL    HISTORY.  ]61 

here  find  time" and  means  to  devote  their  lives  to 
experimental  inquiries ;  and  hence  we  have  none 
who  can  fairly  be  compared  to  a  Bell,  a  Majendie, 
etc.  But  owing  to  the  rapid  re-publication  of 
books,  and  the  numerous  medical  periodicals  in 
our  country,  the  profession  is  readily  supplied 
with  the  valuable  investigations  occurring  in 
Europe,  whether  written  in  English,  French,  or 
German  ;  and  those  investigations  are  as  readily 
and  thoroughly  sifted  for  whatever  they  may 
contain  susceptible  of  practical  application.  We 
have  now  finished  the  strictly  historical  part  of 
our  task,  and  shall  proceed,  in  a  supplementary 
chapter,  to  enter  more  fully  into  the  [present 
condition  and  wants  of  the  profession,  and  the 
proper  means  for  supplying  those  Wants. 


CHAPTER  IV. 

THE  PRESENT  CONDITION  AND  WANTS    OF    THE    PRO- 
FESSION, AND    THE   REMEDIES   FOR   THOSE  WANTS. 

There  are,  probably,  between  thirty  and  forty 
thousand  practitioners  of  medicine  in  the 
United  States,  claiming  to  belong  to  the  regular 
profession.  Of  those  residing  in  the  eastern  and 
middle  states,  far  the  larger  portion  have  regularly 
studied  three  years,  attended  tw->  courses  of  lec- 
tures, and  obtained  a  diploma  from  some  medical 
college.  According  to  a  report  made  by  a  com- 
mittee, and  found  in  the  annual  volume  of  Trans- 
actions of  the  American  Medical  Association  for 
1848,  it  appears  that  of  nine  hundred  and  seventy- 
two  physicians  practicing  in  seventy-five  towns 
and  counties  of  Virginia,  taken  promiscuously 
from  all  sections  of  the  state,  only  six  hundred 
and  seventy-eight  were  graduates  of  any  medical 
school,  or  possessed  any  form  of  license  to  prac- 
tice. Of  the  remaining  two  hundred  and  forty- 


MEDICAL    HISTORY.  163 

nine,  one  had  attended  two  courses  of  lectures, 
ten  had  attended  one  course,  leaving  two  hundred 
and  thirty-eight,  or  one  fourth  of  the  whole  num- 
ber, without  having  attended  any  medical  lee- . 
tures,  or  pursued  any  systematic  course  of  medi- 
cal study. 

This  may,  doubtless,  be  taken  as  a  fair  sample 
of  the  state  of  the  profession,  in  this  particular, 
throughout  the  southern  states.  -  In  most  of  the 
western  states,  I  am  satisfied,  both  from  inquiries 
and  personal  observation,  that  scarcely  one-half 
of  the  whole  number  of  practitioners  have  ever 
been  examined  or  licensed,  either  by  colleges  or 
societies,  and  very  many  of  them  have  never  at- 
tended a  lecture  in  any  medical  institution.  While, 
as  I  have  already  shown,  the  legislatures  of  most 
of  the  states  have  freely  granted  charters  for 
medical  colleges,  and  passed  acts  incorporating 
medical  societies,  scarcely  one  of  them  present, 
now,  any  practical  provisions  for  protecting  the 
health  and  lives  of  the  citizens  from  ths  grossest 
and  most  fatal  impositions,  both  from  within  and 
without  the  regular  profession;  hence,  every 
species  of  medical  delusion  and  imposition  is  al- 
lowed to  spring  up  and  grow  without  any  legal 
restraint.  The  public  press,  that  engine  all  pow- 
erful alike  for  good  or  evil,  lends  itself  freely  as 
the  hired  vehicle,  for  heralding  every  variety  of 


164  MEDICAL    HISTORY. 

pretended  medicinal  compound  or  nostrum,  that  the 
ingenuity  of  man  can  invent.  Indeed,  without  this 
aid  of  the  public  press,  and  the  patronage  of  the 
patent  department  of  our  government,  neither  the 
various  forms  of  quackery,  nor  the  gigantic  system 
of  nostrum  vending,  which  annually  take  millions 
of  dollars  from  the  credulous  and  unsuspecting, 
would  eve?  find  access  to  popular  favor.  In  this 
matter,  the  conductors  of  the  political,  literary, 
and  even  religious  press,  are  unconsciously  bear- 
ing a  responsibility  of  tremendous  weight — we 
say,  unconsciously,  for  surely  we  cannot  suppose 
that  this  large  class  of  enlightened  men  are  aware 
of  the  nature  or  extent  of  the  evils  of  which  they 
are  the  chief  supporters.  Did  they  know  what  a 
little  serious  investigation  would  soon  teach  them, 
viz.,  the  greediness  with  which  persons,  laboring 
under  chronic  or  imaginary  ailments,  catch  at  the 
confident,  alluring,  and  certain  promises  of  relief, 
held  out  in  the  medical  advertisements  of  every 
newspaper  that  reaches  .their  fireside,  and  the 
consequent  millions  of  money  which  they  are 
thereby  induced  to  pay  for  what  is  to  them  of  no 
value  whatever,  and  what,  in  reality  is,  in  nine 
hundred  and  ninety-nine  cases  out  of  every  thou- 
sand, a  simple  mixture  of  the  common  drugs, 
known  and  used  by  the  medical  faculty  for  ten 
centuries,  we  are  sure  thev  would  cease  to  lend 


MEDICAL    HISTORY.  165 

themselves,  as  paid  instruments,  for  carrying  on 
such  a  wholesale  system  of  swindling.  I  am 
not  now  speaking  at  random,  or  in  the  exagge- 
rated terms  of  prejudice,  for  I  have  taken  the 
trouble  to  examine  this  subject  with  some  degree 
of  care,  and  I  find  that,  estimating  the  pay  for 
each  medical  advertisement,  in  our  daily  and 
weekly  journals,  at  the  moderate  sum  of  five  dol- 
lars per  annum,  it  would  amount  to  more  than 
one  hundred  thousand  dollars ;  and  if  we  allow  this 
sum  paid  for  advertising  to  constitute  one-tenth  of 
the  entire  proceeds  of  the  sale  of  such  medicines, 
we  shall  have  the  enormous  sum  of  one  million 
dollars  annually  taken  from  the  pockets  of  the 
people,  not  only  without  an  equivalent,  but  for 
what  is  worse,  a  positive  injury  to  their  health 
and  happiness. 

Our  legislators,  in  their  wisdom,  have  enacted 
just  and  severe  laws  against  frauds,  and  the  ob- 
taining of  goods  or  money  by  false  pretenses. 
Hence,  if  a  man  goes  to  a  merchant  and,  by  false 
representations,  obtains  from  him  fifty  dollars 
worth  of  goods  on  credit,  he  may  be  indicted,  dis- 
graced, and  punished.  But  the  publisher  of  a 
newspaper  may  daily  send  to  the  fireside  of  the 
invalid,  the  most  bold  and  reckless  statements  in 
regard  to  certain  pretended  remedies,  and  thereby 
induce  him,  not  only  to"  spend  fifty  dollars  in 


166  MEDICAL    HISTORY. 

money,  but  perhaps,  also  to  trifle  away  the  only 
time  that,  if  rightly  improved,  would  save  him 
from  a  premature  death,  and,  instead  of  being 
punished  for  the  fraud,  he  cooly  pockets  his  fee, 
and  calls  it  a  fair  business  transaction.  But  I 
would  seriously  ask  these  men,  whether  it  is  the 
greater  crime  to  defraud  the  man  of  business  in 
health,  with  his  eyes  open,  or  the  poor  invalid, 
enfeebled  in  body  and  mind,  and  predisposed  to 
catch  at  every  alluring  promise  that  designing 
men  may  make.  In  our  view,  the  latter  is  as 
much  more  criminal  than  the  former  as  health  is 
more  valuable  than  money.  Indeed,  I  think  it 
high  time  that  both  statesmen  and  publishers 
should  bestow  a  little  serious  attention  on  this 
subject. 

Of  the  thirty-six  or  thirty-seven  medical  colleges 
now  in  active  operation  in  our  country,  only  six- 
teen are  so  located  as  .to  afford  those  in  attend- 
ance on  them,  as  students,  any  opportunity  for 
witnessing  hospital-  or  bedside  instruction,  five 
continue  their  regular  courses  of  lectures  less  than 
sixteen  weeks ;  twenty-six  continue  from  sixteen 
to  eighteen  weeks  ;  two  have  extended  their 
courses,  in  compliance  with  the  advice  of  the 
National  Convention  of  1847,  and  which  has  been 
reiterated  by  every  meeting  of  the  American 
Medical  Association  since,  to  little  more  than  five 


MEDICAL    HCSTORY.  1C7 

months.  These  are  the  University  of  Pennsyl- 
vania and  the  College  of  Physicians  and  Surgeons 
of  the  state  of  New  York.  The  newly  organized 
medical  department  of  the  University  of  Michigan 
is  to  continue  its  regular  term  seven  months,  and 
that  of  the  University  of  Virginia  extends  to  ten, 
as  already  stated  in  the  preceding  chapter,  The 
requisitions  for  graduation  are  pretty  uniformly 
the  same  in  all,  viz.,  the  attainment  of  twenty-one 
years  of  age,  the  presentation  of  certificates  of 
good  moral  character,  of  having  studied  medicine 
three  years,  of  having  attended  two  full  courses 
of  lectures  in  some  regularly  incorporated  medi- 
cal college,  and  a  written  thesis  on  some  medical 
subject.  We  have  at  present  no  less  than  eighteen 
medical  periodicals,  of  which  three  are  published 
quarterly,  five  bi-monthly,  eight  monthly,  and  two 
weekly.  A  large  majority  of  them  are  under  the 
editorial  charge  of  those  connected  as  professors 
with  medical  schools  ;  and  though  most  of  them 
are  conducted  with  an  ability  and  zeal  that  would 
do  honor  to  the  profession  in  any  country,  yet 
they  necessarily  represent  the  sentiments  of  the 
several  colleges,  rather  than  those  of  the  great 
body  of  the  profession.  The  social  organization 
of  the  profession  in  most  of  the  states  is  exceed- 
.  ingly  imperfect.  In  some,  there  is  a  simple  state 
society,  embracing  a  few  of  the  leading  practi- 


168  MEDICAL  HIST011Y. 


tioners  in  the  state ;  whij$  others  have  both  state 
and  district  or  county  societies,  embracing  nomi- 
nally nearly  all  the  regular  members  of  the  pro- 
fession. But  I  doubt  whether  there  is  a  single 
state  in  the  Union  in  which  one  half  of  the  prac- 
titioners are  in  the  habit  of  meeting  their  brethren 
in  a  social  capacity  an  average  of  once  a-year ; 
although  in  this  respect  a  great  improvement  has 
taken  place  since  the  meeting  of  the  first  National 
Medical  Convention,  in  1846. 

But  without  entering  more  fully  into  detail  in 
regard  to  the  present  condition  of  the  profession, 
its  wants  may  be  summed  up  as  follows,  viz. : — 

1st.  The  adoption  of  some  plan  which  shall 
insure  the  practical  enforcement  of  the  standard 
of  preliminary  education  agreed  upon  in  the 
National  Convention  of  1847. 

3d.  The  adoption  of  a  more  extended  system 
of  medical  instruction,  both  public  and  private, 
and  also  such  a  system  of  examinations  as  will 
;ictually  test  the  qualifications  of  the  candidate. 

3d.  The  accomplishment  of  a  more  complete 
and  thorough  organization  of  the  profession,  on 
such  a  plan  as  to  embrace  in  the  local  societies 
every  regular  and  scientific  practitioner,  and  to 
provide  each  state  with  a  board  of  examiners, 
before  whom  every  candidate  for  admission  into 
the  profession  should  be  examined,  whether  pos-. 


MKUICAL    IIIST'>i;Y.  169 

sessed  of  a  college  degree  or  not.  and,  if  found 
qualified,  he  should  receive  a  certificate  or  dip- 
loma, admitting  him  both  into  the  profession 
and  to  membership  in  the  state  society. 

4th.  We  want  a  fund,  other  than  that  derived 
from  the  voluntary  contribution  of  members, 
which  shall  be  devoted  exclusively  to  the  support 
of  the  professional  organization  of  each  state, 
and  the  direct  'promotion  of  original  investiga- 
tion in  the  various  branches  of  medical  science. 

5th.  We  want  to  adopt  such  a  system  of  col- 
lege organization  and  rate  of  lecture  fees,  as  will 
induce  a  far  larger  proportion  of  those  who  prac- 
tice medicine,  to  first  qualify  themselves  tho- 
roughly for  the  responsible  duties  they  assume  to 
perform. 

To  most  of  these  propositions,  every  enlight- 
ened member  of  the  profession  will  readily  yield 
his  assent.  But  then  comes  the  all-important 
question — How  are  these  wants  to  be  supplied  ? 
or,  in  the  language  of  Professor  Jackson,  "  What 
remedies  can  reach  them?"  In  regard  to  the 
first  proposition,  we  have  already  seen  in  the  his- 
torical part  of  this  work,  that  the  initiatory  step 
for  its  accomplishment  has  been  taken.  The  late 
National  Convention,  assembled  in  Philadelphia, 
proclaimed  a  standard  of  preliminary  education, 
and  earnestly  recommended  its  adoption  by  the 


170  MEDICAL    HISTORY. 

whole  profession ;  and  we  are  happy  to  see  that 
the  recommendation  is  being  cordially  seconded 
by  state  and  local  societies  in  almost  every  sec- 
tion of  the  country.  This  standard  makes  it 
necessary  that  every  applicant  for  admission  into 
the  office  of  a  physician,  as  a  student  of  medicine, 
shall  satisfy  such  physician  that  he  has  "  acquired 
a  good  English  education,  a  knowledge  of  natu- 
ral philosophy,  and  the  elementary  mathematical 
sciences,  including  geometry  and  algebra;  and 
such  an  acquaintance,  at  least,  with  the  Latin 
and  Greek  languages,  as  will  enable  him  to 
appreciate  the  technical  language  of  medicine, 
and  read  and  write  prescriptions." 

If  we  take  a  glance  at  the  vast  field  of  medi- 
cal science,  and  reflect  on  the  discipline  of  rnind 
which  ought  to  be  brought  to  the  task  of  its  suc- 
cessful acquirement ;  and  also,  on  the  important 
collateral  bearing  that  almost  every  other  branch 
of  science  has  on  it,  we  shall  readily  see  that  the 
standard  recommended  is  defective  and  inade- 
quate. Still,  it  is  a  great  and  important  advance 
from  no  standard  at  all ;  and  is  perhaps  as  high 
as  it  would  be  wise  to  demand  at  this  time.  But 
we  hope  the  day  is  not  far  distant  when  it  will  be 
made  to  include  every  branch  of  natural  science, 
and  the  French  and  German  languages ;  and  we 
also  hope  that  some  more  efficient  measures  will 


MEDICAL    HISTORY.  171 

be  speedily  adopted  for  carrying  into  practical 
operation  the  standard  already  recommended. 
It  is  true  that  many  of  the  medical  societies  have 
adopted  resolutions,  making  it  the  duty  of  every 
member  to  receive  no  student  who  does  not  first 
satisfy  him,  either  by  personal  examination  or 
written  certificates  from  competent  persons,  that 
he  has  complied  with  the  above  requisitions. 
This  however,  is,  leaving  the  matter  altogether 
too  much  exposed  to  the  influence  of  personal 
friendship,  individual  partiality,  and  other  inte- 
rested motives.  The  only  way  that  any  standard 
of  preliminary  education  can  be  effectually  car- 
ried out  in  practice  is,  -by  establishing,  in  connec- 
tion with  every  regularly  organized  medical 
society,  a  board  of  censors  for  preliminary  exa- 
mination, whose  duty  it  shall  be  to  examine  every 
applicant  for  admission  into  the  office  of  any 
member  of  such  society  ;  and  no  applicant  should 
be  received  without  the  certificate  of  such  board, 
signed  by  a  majority  of  its  members.  This  would 
certainly  be  placing  no  unnecessary  burthen  on 
the  student ;  for  there  would  be  more  propriety, 
and  far  more  justice  too,  in  rejecting  an  unpre- 
pared applicant  at  the  outset,  than  in  permitting 
him  to  spend  three  years'  time  and  some  hundreds 
of  dollars,  and  then  either  rejecting  him.  or  im- 
posing him  a  curse  on  the  community,  and  a 


172  MEDICAL    HISTORY. 

disgrace  to  the  profession.  Indeed,  it  is  surpris- 
ing that  this  initiatory  entrance,  this  outer  gate 
of  the  profession,  has  been  so  long  left  wide  open, 
and  entirely  unguarded ;  for  it  not  only  operates 
injuriously  to  the  honor  of  the  profession  and  the 
interests  of  the  community,  but  it  works  still 
more  injuriously  on  the  individuals  concerned. 

For  members  of  the  profession  to  receive  young 
men  into  their  offices,  who  are  totally  unprepared 
by  previous  mental  discipline,  by  literary  and 
scientific  acquirements,  or  by  good  moral  cha- 
racter,'to  enter  successfully  upon  the  extensive, 
laborious,  and  difficult  branches  of  medical  science, 
is,  indeed,  the  hight  of  injustice.  If  they  are 
finally  rejected,  they  have  spent  that  time  and 
money  for  nought,  which,  if  otherwise  applied, 
might  have  placed  them  in  a  prosperous  and  re- 
spectable position  in  society ;  and,  if  admitted, 
they  suffer  a  still  greater  wrong — they  are  thereby 
ushered  into  a  profession,  whose  honor  they  are 
incapable  of  maintaining ;  they  are  called  to  act 
in  a  sphere  for  which  they  are  unqualified ;  in  a 
word,  they  are  placed  in  a  false  position  in  so- 
ciety— and  that  I  deem  the  worst  of  all  posi- 
tions. Hence,  the  admission  of  unqualified  mem- 
bers into  the  medical  profession,  whether  as 
students  or  practitioners,  is  an  act  of  threefold 
injustice,  —  that  is,  unjust  to  the  individual 


MEDICAL    HISTORY.  173 

admitted,  to  the  whole  profession,  and  to  the 
community  at  large.  I  dwell  with  greater  em- 
phasis on  this  subject  of  preliminary  .education, 
not  only  because  here  has  been  one  of  the  great- 
est defects  in  our  past  system,  but  I  am  satis- 
fied that  here  must  be  laid  the  foundation  of  all 
real  reform  or  improvement.  I  am  well  aware 
of  the  objections  that  have  been  a  thousand  times 
urged,  viz. — that  by  adopting  such  a  standard, 
and  rigorously  adhering  to  it,  we  should  hinder 
many  young  men,  of  strong  minds  and  noble  am- 
bition, but  with  little  pecuniary  means,  from  en- 
tering our  ranks;  while  from  this  class  have 
hitherto  arisen  many  of  the  brightest  ornaments 
of  the  profession. 

While  I  freely  admit  the  truth  of  the  last 
paragraph,  we  wholly  deny  that  of  the  first ;  and 
tor  the  correctness  of  my  views,  I  ask  no  bet- 
ter evidence  than  is  afforded  by  the  very  cases 
usually  adduced  for  the  opposite  purpose,  viz. — 
those  who  have  risen  from  the  lowest  pecuniary 
circumstances,  and  the  most  limited  educational 
advantages,  to  the  highest  rank  in  the  medical 
world ;  for  no  man  can  rise  from  an  attentive 
perusal  of  the  lives  and  characters  of  these  men 
without  being-  satisfied  first,  that  their  mental 
energy  was  equal  to  the  accomplishment  of  any 
reasonable  requisitions ;  and  second,  that  they 


174  MEDICAL    HISTORY. 

were  obliged  to  acquire,  after  their  admission, 
just  what  should  have  been  done  before,  and 
thereby  suffered  innumerable  embarrassments, 
some  of  which  seriously  impaired  their  usefulness 
through  life.  No ;  it  is  not  the  strong  minded 
and  nobly  ambitious  son  of  the  poor  man  who  is 
discouraged  by  ordinary  obstacles,  or  stopped  be- 
cause of  any  just  requirements ;  for  upon  his 
banner  is  ever  inscribed,  in  indelible  characters, 
nil  desperandum,  perseverantia  omnia  vincit ; 
and,  if  need  be,  he  can  roast  his  own  potatoes, 
and  subsist  on  twenty-five  cents  per  week,  rather 
than  relinquish  his  objects.  But  it  is  the  vacilat- 
ing,  the  imbecile,  and  those  who  have  been 
cradled  in  the  lap  of  luxury,  who  faint  at  obsta- 
cles, or  continually  cry  out,  in  the  language  of 
the  good  book,  for  '•'  a  little  more  slumber,  a  little 
more  folding  of  the  hands  to  sleep ;"  who  spend 
half  their  lecture  terms  in  eating  houses  and 
places  of  amusement ;  or  who  leave  the  college 
when  only  three  of  the  four  short  months  have 
passed  away.  Indeed,  the  young  man  who  has 
not  sufficient  industry  and  energy  of  character 
to  qualify  himself  for  entrance  upon  medical 
studies,  when  such  qualifications  are  fairly  pointed 
out  to  him,  is  not  calculated  either  to  honor  the 
profession  or  do  justice  to  the  community, — and 
hence  the  more  effectually  he  is  stopped  at  the 


MEDICAL    HISTORY.  175 

threshold,  at  the  first  initiatory  step,  the  better  it 
is  for  all  parties. 

The  propriety  of  the  second  proposition  is  no 
less  manifest  than  the  first.  That  the  true  rela- 
tions of 'preceptor  and  pupil  are  greatly  neglected ; 
that  the  duties  of  the  former  are  too  often  made 
to  consist  in  simply  furnishing  a  slovenly  office 
and  a  musty  library ;  and  those  of  the  latter,  in 
reading  a  limited  series  of  text-books,  without 
order  or  method,  and  often  without  a  question 
once  a-month,  is  a  humiliating  truth.  And  if  the 
recent  National  Conventions,  and  the  American 
Medical  Association,  which  has  grown  out  of 
them,  should  do  no  more  than  to  establish  in 
practice  a  liberal  standard  of  preliminary  educa- 
tion, and  a  proper  system 'of  private  instruction 
and  pupilage,  it  would  be  a  blessing  to  mankind 
of  sufficient  magnitude  to  enroll  the  names  of 
their  authors  among  the  benefactors  of  our  race. 

The  truth  is,  that  no  man  should  admit  a 
student  into  his  office,  unless  he  is  willing  and 
able  to  devote,  at  least,  an  hour  per  day  for  two 
days  in  each  week,  to  systematic  examinations  of 
such  student,  accompanied  by  familiar  illustra- 
tions and  experiments,  in  whatever  branches  he 
may  be  pursuing  at  the  time.  He  should  also  see 
that  the  course  of  study  is  judiciously  arranged 
and  methodically  pursued,  ever  remembering  that 


176  MEDICAL    llIriTOKY. 

the  acquisition  of  knowledge  is  one  thing,  and  the 
attainment  of  true  mental  discipline  and  correct 
habits  of  thought,  is  another,  and  scarcely  less 
important  thing.  And  it  is  equally  incumbent  on 
the  preceptor,  during  the  last  year  of  the  student's 
pupilage,  to  make  him,  as  far  as  possible,  his  com- 
panion in  visiting  the  sick — not  merely  in  witness- 
ing important  surgical  operations,  but  just  as  far 
as  a  true  sense  of  propriety  and  the  feelings  of 
patients  will  permit,  also,  to  the  ordinary  bed-side 
practice,  that  he  may  be  able  to  go  out,  not  only 
well  skilled  in  the  great  leading  principles  of 
medicine,  but  also  familiar  with  those  practical 
details  which  make  up  so  much  of  the  daily  duties 
of  the  physician; 

It  would,  doubtless,  tend  much  to  the  elevation 
of  the  business  of  private  teaching,  if  the  estab- 
lishment of  regular  private  medical  schools  was 
everywhere  encouragsd.  By  such  means  the 
work  would  be  concentrated  in  fewer  hands,  and 
those  almost  necessarily  better  qualified,  both  by 
their  natural  inclinations,  and  their  scientfic  at- 
tainments;  and  the  students,  by  being  thus  con- 
gregated in  small  classes,  would  keep  alive  in  each 
other  the  spirit  of  emulation,  and  would  effectu- 
ally prevent  their  becoming  mere  "  office  keepers," 
instead  of  men  ardently  devoted  to  the  task  of 
mastering  an  extensive  and  intricate  profession. 


MEDICAL    HISTORY.  177 

And,  in  regard  to  the  period  of  public  instruc- 
tion in  our  medical  colleges,  there  seems  to  be  but 
one  opinion  in  the  profession,  and  that  is,  that  the 
term  of  four  months,  s  long  and  universally 
adopted  in  this  country,  is  entirely  too  short, 
either  for  the  professors  to  fairly  present  their 
respective  branches,  or  for  the  students  to  properly 
digest  the  matter  which  is  offered  them.  So 
manifest,  indeed,  is  this  truth,  that  the  recent 
National  Convention,  after  mature  deliberation, 
almost  unanimously  passed  a  resolution  strongly 
recommending  an  extension  of  the  college  term 
to  six  months.  And,  if  any  further  evidence  was 
wanting,  we  have  it  in  the  valedictory  of  almost 
every  professor  in  the  country.  For  the  number 
of  them  who  do  not  annually  set  forth  the  short- 
ness of  time  allowed  them,  as  their  apology  for 
having  omitted  many  things  of  importance,  is 
very  small  indeed.  And  not  a  few,  like  the  illus- 
trious professor  of  surgery  in  the  University  of 
New  York,  close  their  four  months'  work  by  in- 
forming their  classes  that  they  have  scarcely 
passed  over  half  of  their  course.  The  very  idea 
of  presenting  to  the  mind  of  a  student  all  the 
various  branches  of  medical  science — anatomy, 
general  and  special,  physiology  and  pathology, 
chemistry  and  materia  medica,  obstetrics  and 

diseases  of  women  and  children,  theory  and  prac- 

8*   . 


178  MEDICAL    HISTORY. 

tice  of  medicine,  principles  and  practice  of  sur- 
gery, medical  jurisprudence,  etc.,  together  with 
practical  anatomy  by  dissections — all  in  the  space 
of  sixteen  weeks,  is  in  itself  so  absurd,  that  the 
reflecting  mind  wonders  why  it  was  ever  seriously 
attempted.  The  practical  effect  of  such  short 
terms  has  been  to  cause  almost  every  student  to 
neglect  two  or  three  of  the  branches  taught  in 
the  colleges,  for  the  sake  of  gaining  time  to  pay 
the  requisite  attention  to  the  rest ;  and,  as  a  mat- 
ter of  course,  the  neglected  branches  are  generally 
those  which  are  supposed  to  have  the  least  direct 
utility  at  the  bedside  of  the  sick,  and  will  be  most 
leniently  passed  over  in  the  final  examination. 
Hence,  while  most  of  our  graduates  leave  the 
colleges  tolerably  well  versed  in  the  ordinary  de- 
tails of  medical  and  surgical  practice,  very  few, 
indeed,  have  even  a  superficial  knowledge  of 
general  anatomy,  physiology,  medical  jurispru- 
dence, or  chemistry.  The  consequences  of  this 
are  exceedingly  injurious,  both  to  the  profession 
and  the  community.  If  the  daily  visits  to  the 
sick  constituted  the  whole  duty  of  the  physician, 
the  slighting  of  certain  less  directly  practical 
branches  would  be  a  matter  of  minor  consequence, 
although  they  are  even  here  capable  of  valuable 
application  almost  every  day.  But,  when  we 
remember  that  there  is  not  a  member  of  the  pro- 


MEDICAL    HISTORY.  179 

fession,  in  the  remotest  corner  of  the  country, 
who  is  not  liable  to  be  called  on  for  medico-legal 
opinions  and  investigations,  and  on  the  correct- 
ness of  which  may  depend,  not  only  the  mainten- 
ance of  justice,  the  health  of  the  community,  but 
also  the  reputation  and  lives  of  his  fellow-men,  we 
begin  to  appreciate  the  magnitude  of  the  evil. 
Indeed,  there  is  scarcely  a  judicial  district  in  the 
country,  that  has  not  suffered  the  loss  of  thousands 
of  dollars,  seen  the  ends  of  justice  totally  defeated, 
and  the  reputation  of  the  profession  itself  lowered 
in  the  estimation  of  the  community,  from  the  lack 
of  a  competent  knowledge  of  chemistry  and  medi- 
cal jurisprudence  on  the  part  of  medical  men. 
Hence,  we  have,  as  an  invariable  result  of  a  four 
months'  college  term,  either  the  acquisition  of  a 
very  superficial  knowledge  of  all  the  branches  of 
medicine,  or  the  neglect  of  some  for  the  more 
thorough  study  of  the  others.  Suppose  a  class  in 
one  of  our  academies  or  literary  colleges  were 
seriously  requested  to  thorougly  review  their 
natural  philosophy,  chemistry,  astronomy,  algebra, 
geometry,  botany,  and  moral  philosophy,  all  in  the 
short  space  of  sixteen  weeks,  would  they  not  ridi- 
cule both  the  proposition  and  its  inventor  ?  And 
yet  these  branches  of  science  fall  far  short,  in 
number  and  intricacy,  those  presented  to  the 
medical  class  during  each  lecture  term. 


180  MEDICAL    HISTORY. 

Yet,  plain  as  may  rtppear  the  necessity  of  re- 
form, in  this  respect,  to  an  uninterested  observer, 
still,  the  colleges  seem  to  enter  on  it  with  extreme 
reluctance.  This  arises  chiefly  from  two  causes, 
viz. — mutual  jealousy  or  rivalship,  and  the  fear 
that  students  cannot  be  induced  to  attend  a  period 
of  six  months. 

The  time  has  been,  and  that,  too,  not  long  since, 
when  the  bare  mention  of  this  first  cause  would 
have  been  repelled  as  a  slander  on  our  medical 
institutions;  but  its  powerful  influence  is  being  de- 
monstrated even  at  this  moment  so  clearly,  that 
the  perverted  vision  of  self-interest  itself,  cannot 
fail  to  see  it.  More  than  three  years  since,  the 
whole  profession,  represented  in  a  convention  at 
Philadelphia,  solemnly  declared  its  wish  that  the 
college  terms  might  be  extended  to  six  months. 
One  or  two  out  of  the  whole  number  promptly  re- 
sponded to  this  wish,  a  few  others  timidly  advanced 
from  sixteen  weeks  to  eighteen  or  twenty,  while 
far  the  greater  number  contented  themselves  with 
the  declaration,  that  they  were  ready  to  complv 
with  the  request  so  soon  as  it  shall  appear  that  all 
the  other  colleges  will  do  so  to.  Thus  it  is  not 
because  the  professors  are  unwilling  to  lecture  a 
longer  time,  not  because  it  would  increase  the 
expenses  of  the  colleges,  but,  in  plain  English,  be- 
cause each  college  fears  to  lay  a  single  item  of 


MEDICAL    HISTORY.  181 

burthen  on  the  student,  even  in  the  way  of  afford- 
ing him  greater  facilities  for  obtaining  knowledge 
lest  some  neighboring  college,  by  failing  to  add 

O  o  •/ 

such  burthen,  should  prove  a  more  successful 
rival. 

The  second  reason  for  not  extending  the  period 
of  college  instruction,  is  equally  the  exclusive  fault 
of  the  institutions  themselves.  I  very  well  re- 
member that  in  the  same  convention  to  which  I 
have  alluded,  it  was  urged  by  Professor  Mitchell, 
of  Transylvania  University,  Professor  Hare,  of. 
Philadelphia,  and  others,  that  it  would  be  useless 
to  extend  the  college  -term,  for  it  was  now  a  noto- 
rious fact,  that  scarcely  half  the  students  could  be 
kept  together  through  a  term  of  four  months,  and 
much  less  would  they  attend  six.  It  was  even 
said,  and  truly,  too,  that  very  many  do  not  now 
arrive  at  the  college  until  the  term  is  nearly  half 
gone,  and  others  leave  a  month  or  six  weeks 
before  its  close.  Now,  there  is  a  very  plain  rea- 
son why  these  things  are  so.  It  is  simply  because 
the  colleges  keep  their  matriculating  books  open 
until  the  middle  of  their  terms,  and  credit  stu- 
dents for  full  courses  whoi  leave  before  three- 
fourths  of  the  lectures  have  been  given.  If  a  man 
should  employ  a  dozen  laborers,  and  let  them 
know  in  the  beginning  that  he  should  give  them 
credit  for  a  full  day's  work  though  they  should 


182  MEDICAL  HISTOUY. 

not  actually  labor  six  hours  out  of  the  twenty- 
four — does  any  one  suppose  his  men  would  be 
very  particular  about  going  to  their  work  at  a 
very  seasonable  hour  in  the  morning,  or  remaining 
at  it  until  the  usual  time  in  the  afternoon  ?  Cer- 
tainly not.  And  yet,  such  a  supposition  would  be 
just  as  reasonable  as  to  expect  all  our  medical 
students  to  attend  punctually  the  entire  college 
term,  whether  it  be  four  or  six  months,  while  they 
know  very  well  that  they  can  get  their  names 
duly  registered,  and  obtain  the  same  objects,  by 
attending  scarcely  more  than  half  of  that  period. 
If  all  our  medical  colleges  should  adopt,  and 
rigidly  adhere  to  the  rule,  that  no  student  should 
be  credited  for  a  full  term  who  failed  to  be  pre- 
sent and  take  his  matriculating  ticket,  within  ten 
days  from  the  commencement  of  the  regular 
term,  or  who  should  leave  more  than  ten  days 
before  its  close,  we  are  satisfied  that  there  would 
be  very  little  difficulty  in  keeping  the  classes 
together  during  any  length  of  term  which  might 
be  agreed  on.  Hence,  it  is  plain  that  this  objec- 
tion, which  is  the  only  real  one  urged  by  the  col- 
leges against  the  adoption  of  the  six  months'  term, 
has  its  whole  foundation  in  their  own  erroneous 
practice.  And  it  could  be  urged,  with  just  as 
much  propriety  and  force,  against  a  three,  as  a 
six  months'  course,  for  in  either  case  it  would  be 


MEDICAL    HISTORY.  183 

allowing  the  colleges  to  take  advantage  of  their 
own  errors.  But  the  real  difficulty  here  is  the 
same  as  in  the  preceding  case,  viz. — the  rivalry 
and  want  of  concert  existing;  among  the  several 

.  o  o 

schools.  Thus,  if  a  student  applies  for  admission 
into  one  of  our  colleges  six  weeks  after  the  com- 
mencement of  the  term,  the  faculty  dare  not  re- 
fuse him,  lest  he  turn  on  his  heel  and  walk  di- 
rectly into  the  halls  of  some  rival  institution ; 
and  yet  there  are  those  among  us  who  seem  to  see 
nothing  in  the  multiplication  of  medical  schools, 
and  the  active  rivalry  carried  on  among  them,  in 
the  least  degree  calculated  to  lower  the  standard 
of  education  in  the  profession.  But  if  our  sys- 
tem of  instruction,  both  public  and  private,  needs 
improvement  and  extension,  the  mode  of  exami- 
nation for  testing  the  qualifications  of  the  student, 
and  admitting  him  into  the  ranks  of  the  profession, 
needs  it  still  more, 

We  have  already  shown,  in  the  historical  part 
of  this  work,  that  the  college  diploma  has  been 
recognized  as  a  sufficient  license  to  practice 
medicine  and  surgery  in  almost  every  state  in 
the  Union,  and,  consequently,  it  has  now  become 
almost  the  only  regular  passport  into  the  ranks  of 
the  profession.  In  several  of  the  states,  as  in 
New  York,  this  is  made  so  by  the  laws  granting 
the  charters  of  the  several  schools,  while  in  others 


184  MEDICAL    HISTORY. 

the  diploma  of  the  college  is  made  a  sufficient  evi- 
dence of  qualifications,  by  the  laws  establishing 
state  and  district  board  of  censors,  or  by  the  rules 
adopted  by  the  boards  themselves.  Hence,  prac- 
tically, the  business  of  teaching  and  licensing  is 
united  in  the  same  persons,  and,  with  a  very  few 
partial  exceptions,  these  persons  are  exclusively 
the  officers  and  professors  in  the  several  medical 
schools.  We  have  also  seen  that  the  means  they 
adopt  for  testing  the  qualifications  of  the  candi- 
dates, generally  consist  of  one  oral  examination, 
continuing  from  fifteen  minutes  to  one  or  two 
hours,  and  a  written  thesis  on  some  medical  subject. 
That  such  means  are  insufficient,  and  entirely 
unsatisfactory,  seems  evident  to  every  impartial 
and  reflecting  mind.  They  are  insufficient,  be- 
cause they  are  addressed  almost  exclusively  to 
the  memory  of  the  student,  without  necessarily 
calling  into  action  ejther  the  perceptive  or  reason- 
ing faculties,  and  hence  they  are  unsatisfactory,  as 
affording  neither  a  test  of  his  quickness  of  per- 
ception, his  soundness  of  judgment,  or  his  ability  to 
apply  both  to  the  practical  duties  of  his  profession. 
If  the  college  diploma  is  to  be  regarded  as  a  mere 
certificate  of  attainment,  or  as  evidence  that  the 
holder  has  attended  a  certain  number  of  lectures, 
then,  the  mode  of  examination  which  the  officers 
and  faculty  adopt,  is  a  matter  of  little  consequence 


MEDICAL    HISTORY.  185 

to  the  profession.  But  when  such  examination  is 
to  constitute  the  test  of  a  student's  fitness  to 
enter  into  the  ranks  of  a  profession,  whose  sole 
business  is  to  guard  the  public  health,  heal  the 
sick,  and  alleviate  human  suffering  in  its  ever 
varying  forms,  it  should  always  be  so  conducted 
as  to  secure  fully  the  following  objects  and  condi- 
tions, viz. : —  -  *•  • 

1st.  The  examining  board  should  be  so  consti- 
tuted as  to  possess  no  interest  whatever  in  the 
result  of  the  examinations,  either  direct  or  indi- 
rect, pecuniary  or  moral.  If  a  juryman  is  selected 
to  determine  an  issue  between  two  neighbors,  in- 
volving a  value  of  twenty  shillings,  he  must  not 
only  be  sworn  to  decide  impartially,  but  must  also 
be  entirely  free  from  all  interest  in  the  result  of 
the  decision,  and  free  from  having  even  expressed 
an  opinion  in  regard  to  the  merits  of  the  case. 
The  same  is  equally  true  of  the  justice  or  the 
judge  on  the  bench.  Indeed,  the  principle  of  en- 
tire disinterestedness  on  the  part  of  those  who,  in 
any  or  all  the  relations  of  life,  are  to  act  as  judges 
of  the  rights  and  interests  of  others,  is  so  inter- 
woven with  all  our  ideas  of  justice,  that  nothing 
would  elicit  more  speedy  or  universal  censure, 
than  its  designed  transgression  in  any  of  the  ordi- 
nary business  transactions  in  life ;  and,  if  the 
principle  is  thus  sacred  when  applied  to  the  ordi- 


186  MEDICAL    HISTORY. 

nary  pecuniary  transactions  between  man  and 
man,  how  much  more  so  should  it  be  when 
brought  to  bear  directly  on,  not  only  the  honor 
and  usefulness  of  a  noble  profession,  but  also  on 
the  health,  and  even  lives,  of  hundreds  and  thou- 
sands of  our  fellow-men. 

But  are  the  professors  and  officers  of  our  medi- 
cal colleges  thus  disinterested  in  regard  to  the 
examinations  which  they  conduct  ?  Have  they 
no  interest,  either  direct  or  indirect,  in  the  result  ? 
To  answer  these  questions  satisfactorily,  involves 
a  full  knowledge  of  the  interests  and  motives  of 
every  college  trustee  and  professor.  These  are, 
first,  his  own  personal  reputation  and  that  of  the 
school  with  which  he  is  connected ;  second,  the 
pecuniary  profits  resulting  from  such  connection  ; 
and,  third,  the  desire  to  do  good  as  a  teacher  of 
others. 

That  the  first  two  of  these  objects  are  the  para- 
mount and  controlling  ones  which  govern  the 
conduct  of  professors  in  medical  schools,  as  well 
as  that  of  every  other  class  of  enlightened  men  in 
Christendom,  so  far  as  temporal  matters  are  con- 
cerned, is  too  evident  to  need  a  word  of  comment. 
It  is  equally  evident,  that  these  objects  will  be 
accomplished  just  in  proportion  to  the  number 
and  intelligence  of  the  classes  they  are  able  to 
draw  into  their  respective  schools.  Hence,  it  is 


MEDICAL    HISTORY.  187 

the  first,  and  most  prominent  object  of  those  con- 
nected with  every  school,  to  increase,  as  far  as 
possible,  the  number  of  students  in  attendance. 
For  this  purpose  they  send  forth  their  annual 
catalogues  and  circulars,  enlist  the  co-operation 
of  their  friends,  and  arrange  their  courses  of  in- 
struction, and  of  course  their  examinations  also, 
in  such  a  way  as  they  think  best  calculated  to 
please  and  satisfy  the  students  themselves.  And 
as  the  principal  objects  of  the  student  are,  to  gain 
the  requisite  amount  of  knowledge  with  as  little 
expenditure  of  time  and  money  as  possible,  and 
make  sure  his  success  at  the  final  examination, 
the  strong  and  inevitable  tendency  will  be  for  the 
schools  to  vie  with  each  other  in  their  facilities 
for  the  accomplishment  of  these  two  purposes. 
Thus  to  accommodate  the  dilatory,  the  matricu- 
lating books  are  kept  open  during  half  of  the  en- 
tire term  ;  to  catch  the  poor  they  offer  credit,  or 
even  receive  gratuitously ;  and  to  conciliate  all, 
they  make  the  final  examinations  as  short  and 
lenient  as  their  consciences  will  permit.  And  on 
this  point  the  consciences  of  every  faculty  are 
.  easily  satisfied  with  the  belief,  that  they  examine 
quite  as  rigidly  as  any  of  their  neighbors 
and  rivals.  But  this  is  not  all,  for  every 
diploma  granted  brings  from  fifteen  to  thirty 
dollars  into,  either  the  pockets  of  the  professors 


188  MEDICAL.    HISTOKY. 

or  the   treasury   of    the   school   to  which   they 
belong. 

It  is  thus  seen  that  every  faculty  of  professors, 
so  far  from  being  disinterested  and  impartial 
examiners  of  their  own  classes,  are  under  the 
direct  influence  of  the  strongest  motives  to  swell, 
as  far  as  possible,  the  list  of  successful  candidates. 
These  motives  are  nothing  less  than  personal  re- 
putation and  pecuniary  gain,  stimulated  by  the 
direct  competition  of  rival  institutions.  Hence, 
every  faculty  of  professors  who  resolve  them- 
selves into  a  board  of  examination,  to  sit  in  judg- 
ment on  the  qualifications  of  their  own  students, 
are  placed  in  such  a  position,  that  their  own  per- 
sonal interests  are  in  direct  collision  with  their 
duty  to  the  whole  community,  and  their  regard 
for  the  honor  and  welfare  of  the  profession  to 
which  they  belong.  The  true  position  of  every 
medical  examiner  is  plainly  that  of  a  judge  sitting 
in  judgment  on  the  dearest  interests  of  the  student, 
on  one  side,  and  those  of  the  community  on  the  other. 
Now,  if  the  matter  at  issue  between  these  two 
parties  was  a  few  dollars  in  money,  instead  of  the 
reputation  of  the  one  and  the  health  of  the  other,, 
no  sane  man  would  pretend  that  a  judge  ought  to 
be  placed  over  them  who  was  directly  and 
strongly  interested  in  one  of  the  parties.  And 
is  it  not  equally  a  direct  violation  of  all  correct 


MEDICAL    HISTORY.  189 

principles  to  do  so  in  the  other  case?  If  I 
have  succeeded  in  demonstrating  the  fact,  that 
every  professor  is  necessarily  an  interested 
party  in  everything  relating  to  the  students  in  his 
own  school,  (and  to  deny  it,  is  to  assume  the 
absurd  position  that  he  cares  neither  for  his  own 
reputation  or  the  amount  of  his  own  salary,) 
then  nothing  can  be  more  clear  than  that  the 
union  of  the  business  of  teaching  and  licensing 
in  the  same  persons  is  entirely  "  wrong  in  prin- 
ciple." That  it  is  liable  to  great  abuse  in  prac- 
tice, the  actual  condition  of  the  profession  at  this 
moment  fully  proves;  for  how  else  shall  we  ac- 
count for  the  fact,  that  scores  are  annually  added 
to  the  profession,  with  college  diplomas  in  their 
pockets,  who  are  destitute  alike  of  preliminary 
education  or  sound  medical  knowiedge ;  others 
who  are  open  and  avowed  homceopathists  in  faith 
and  practice ;  and  still  others  who  have  divided 
half  of  the  time  professedly  spent  in  the  college, 
between  the  house  of  ill-fame  and  the  grog-shop  ? 
I  am  not  here  censuring  the  conduct  or  impeach- 
ing the  motives  of  those  connected  with  our  medi- 
cal schools.  They,  like  all  the  rest  of  mankind, 
are  governed  by  a  sincere  and  laudable  desire  to 
advance  the  immediate  interests  and  prosperity  of 
themselves  and  the  institutions  to  which  they  are 
attached.  To  expect  them  to  do  otherwise,  would 


190  MEDICAL    HISTORY. 

be  as  unreasonable  as  contrary  to  the  ordinary 
tendencies  of  human  ixature.  Indeed,  while  every 
student  is  left  free  to  choose  what  college  he  will 
attend,  and  permits  the  question  where  he  can 
most  certainly  and  cheaply  graduate,  to  be  one 
of  the  most  potent  elements  in  determining  his 
choice,  a  faculty  of  professors  could  scarcely  be 
guilty  of  greater  folly  than  the  attempt  to  exact 
of  every  candidate  such  qualifications,  both  moral 
and  intellectual,  as  the  true  interests  of  the  com- 
munity require,  while  they  could  exert  no  con- 
trolling influence  over  the  examinations  of  other 
and  rival  faculties.  But,  in  thus  attributing  the 
present  low  standard  of  education,  and  the  great 
defects  in  the  mode  of  examining  candidates,  to 
the  natural  and  inevitable  workings  of  the  system 
adopted,  we  illustrate  still  more  forcibly  the  in- 
correctness of  the  principle  involved.  It  is  no 
more  than  just,  however,  to  state,  that  there  are 
.  those  who  not  only  insist  on  the  correctness  of 
the  principle  involved  in  the  union  of  teaching 
and  licensing,  but  who  also  contend  that  such 
union  is  beneficial  in  its  practical  operation.  This 
is  the  view  taken  by  the  able  chairman  of  the 
committee  who  reported  on  this  subject  at  the 
National  Convention  in  Philadelphia,  1847,  but 
whose  report  received  the  sanction  of  only  a 
minority  of  the  committee,  and  was  not  adopted 


MEDICAL    HISTORY.  191 

by  the  convention.    His  reasons  for  this  view  are 
thus  presented  in  the  report,  viz.: — 

"  1st,  It  will  probably  be  admitted  that,  taking 
teachers  as  a  body,  they  are  at  least  as  well  qua- 
lified to  conduct  the  examinations,  and  to  judge 
of  the  fitness  or  unfitness  of  candidates  to  be  in- 
vested with  the  privileges  of  the  profession,  as  any 
other  class  of  practitioners. 

"  3d,  Under  the  present  organization,  each 
school  has  it  in  its  power  to  elevate  or  degrade 
the  value  of  its  diploma,  and  to  make  the  posses- 
sion of  it  an  honor,  or  otherwise,  according  to  the 
character  of  the  school  from  which  it  emanates. 
The  faculty  of  each  college  is  interested  in  main- 
taining the  reputation  of  the  institution  with  which 
it  is  connected. 

"  3d.  The  character  of  the  graduates  will,  in  a 
great  measure,  depend  on  the  character,  as  men 
and  as  teachers,  of  the  professors.  When  the 
professors  are  men  of  elevated  sentiments,  the 
students  insensibly  imbibe  the  same  high  tone  of 
feeling.  The  young  graduate  is  proud  of  seeing 
the  names  of  men  whom  he  honors,  and,  perhaps, 
venerates,  attached  to  his  diploma,  while  teachers 
cannot  fail  to  begra.ified  in  attesting  to  the  qua- 
lifications of  diligent  and  well-deserving  pupils. 
It  may  well  admit  oi  doubt  whether  it  would  be 


192  MEDICAL    HISTORY. 

advantageous  to  break  up  this  sympathy  between 
students  and  their  instructors. 

"  4th.  The  teachers  have  the  best  opportunities 
of  knowing  the  characters  and  capabilities  of  candi- 
dates, from  witnessing  their  general  deportment 
in  the  class-room,  etc.  The  necessity  for  good 
behavior,  and  regular  attendance,  for  obtaining 
a  degree,  contributes  greatly  to  secure  that  dis- 
cipline and  decorum  in  the  class-rooms  so  essen- 
tial to  the  advancement  of  the  pupil,  and  the  suc- 
cess of  the  teacher.  If  the  professors  were  to  be 
excluded  from  the  board  of  examiners,  or  not  to 
have  a  preponderating  control,  their  influence 
over  their  classes  would.be  greatly  impaired." 

Such  are  the  reasons  given  for  the  continu- 
ance of  the  union  of  teaching  and  licensing,  by 
one  of  its  ablest  advocates  ;  and  it  may  be  added, 
that  they  are  the  most  plausible  and  ingenious 
that  can  be  adduced.  But,  pray,  what  do  they 
amount  to,  when  weighed  in  the  balance  of  sound 
reasoning  ?  The  abstract  truth  of  the  first,  pro- 
vided the  teachers  have  no  personal  interest  in 
the  success  of  the  candidates  to  be  examined,  no 
one  denies  ;  while  the  others  consist  in  little  else 
than  a  full  admission  of  nearly  all  for  which  we 
have  contended.  Thus,  we  are  told,  in  plain 
terms,  that  the  professors  in  each  college  are 


MEDICAL    HISTORY.  193 

"  interested  in  maintaining  the  reputation  " — i.  e 
the  popularity  and  prosperity — "  of  the  institution 
with  which  they  are  connected  ;" — that  "it  is  in 
their  power  to  elevate  or  degrade  the  value  of  its 
diploma,"  and,  of  course,  also,  the  character  and 
qualifications  of  those  on  whom  they  confer  it; 
— that  there  is  a  strong  and  mutual  bond  of 
"  sympathy  between  students  and  their  instruc- 
tors ;" — and,  finally,  that  the  students  themselves 
are  greatly  influenced  in  their  conduct,  and,  con- 
sequently, in  their  choice  of  colleges  also,  by  the 
fact  that  they  are  dependent  on  the  professors  for 
the  attainment  of  the  chief  object  of  their  am- 
bition, viz. — the  diploma. 

Now,  if  all  this  is  not  a  full  and  explicit  admis- 
sion that  both  teachers  and  pupil  are  strongly  and 
mutually  interested  parties — nay,  but  mutually 
dependent  parties,  then  I  know  not  the  meaning 
of  language.  The  one  is  dependent  for  the  pros- 
perity of  his  school,  the  other  for  his  diploma. 
Hence,  until  it  is  proved  that  it  is  a  correct  prin- 
ciple of  action  to  make  interested  parties  judges 
or  jurors,  it  will  remain  a  stubborn  truth,  that  the 
union  of  teaching  and  licensing  in  the  same  per- 
sons is  "  wrong  in  principle ;"  for  no  sane  man 
will  pretend  that  the  medical  examiner  is  any- 
thing else  than  a  real  judge,  whose  duty  is,  to  pro- 
tect the  dearest  interests  of  the  profession  on  the 


194  MEDICAL    HISTORY. 

one  side,  and  those  of  the  whole  community  on 
the  other.  Neither  am  I  alone  in  asserting  this 
doctrine;  for  so  early  as  1837,  the  same  view 
was  advocated  by  some  of  the  ablest  members  of 
the  faculty  in  Philadelphia.  They  even  went  so 
far  as  to  organize  an  institution  for  the  purpose  of 
examining  candidates  and  conferring  degrees, 
wholly  independent  of  the  business  of  teaching ; 
and  the  legislature  of  that  state  was  petitioned 
for  a  charter,  sanctioning  their  organization  ;  and, 
though  such  petition  was  signed  by  one  hundred 
and  twenty-six  phys:cians,  practitioners  of  Phi- 
ladelphia, including  almost  every  medical  man  of 
note  in  that  city,  not  connected,  officially,  with 
the  two  chartered  schools  then  in  existence  there, 
it  failed  to  meet  with  the  approbation  of  the 
legislature ;  and,  consequently,  it  was  never  fully 
carried  into  operation."*  Again,  at  the  annual 
session  of  the  Medical  Society  of  the  State  of 
New  York,  for  1839,  one  of  the  resolutions  re- 
ported by  a  committee,  was  as  follows,  viz. — 
"Resolved,  That  the  right  of  teaching  ought  to  be 
separated  as  much  as  possible  from  the  power  of 
conferring  diplomas  of  license.''  This  resolution 
was  freely  discussed  by  the  society,  and  adopted, 
by  a  vote  of  fourteen  to  four. 

*  Sae  Eclectic  Journal  of  Medicine,  vol.  i.,  page  80. 


MEDICAL    HISTORY.  195 

The  same  year,  a  committee  was  appointed  by 
the  society,  consisting  of  Drs.  J.  R.  Manly,  of 
New  York,  T.  R.  Beck,  of  Albany,  and  J. 
M'Call,  of  Utica,  to  consider  maturely,  and  report 
on  the  whole  subject  of  medical  education,  at  the 
next  annual  meeting  of  the  society.  The  report 
of  this  committee  was  duly  made  the  following 
year,  by  Dr.  Beck,  and  one  thousand  extra  copies 
were  published  by  the  society  for  distribution. 
In  that  report  we  find  the  following  language, 
viz. : — 

"  But,  in  view  of  the  diploma  becoming  depre- 
ciated by  the  rapid  establishment  of  new  schools, 
it  may  well  become  a  question  deserving  serious 
consideration,  whether,  at  no  distant  period,  the 
right  of  teaching  and  licensing  should  not  be  dis- 
joined  An  incidental 

difficulty  to  the  adoption  of  this  suggestion,  is 
the  fact  that  we  are  surrounded  by  institutions  in 
other  states,  who  might  or  might  not  follow  it, 
and  thus  our  students  might  be  induced  to  desert 
our  own  colleges."  * 

When  we  remember  that  this  is  the  well- 
guarded  language  of  one  of  the  ablest  and  most 
experienced  teachers  in  our  country,  it  is  at  least 
eititled  to  some  consideration;  and  particularly 


*  See  Transactions  of  State  Medical  Society,  vol.  ir.  p.  260, 


196  MEDICAL,    HISTORY. 

the  last  paragraph,  which  is  another  direct  ac- 
knowledgment of  the  powerful  influence  exerted 
over  both  professors  and  pupils  by  the  privilege 
of  granting  degrees. 

The  proposition  for  separating  the  right  of 
teaching  and  licensing  was  again  brought  to  the 
notice  of  the  New  York  State  Society,  at  the 
annual  session  of  1844,  and  through  it,  also  to  the 
notice  of  the  several  county  societies  in  that 
state ;  and  the  published  transactions  of  the  fol- 
lowing year  show,  that  it  not  only  received  the 
sanction  of  the  state  society,  but  also  of  a  very 
large  proportion  of  county  societies  then  in  active 
existence.  It  was,  as  has  already  been  shown  in 
a  previous  chapter,  the  discussion  on  this  proposi- 
tion, at  the  annual  meeting  of  the  state  society, 
in  1845,  that  gave  rise  to  the  call  for  a  National 
Medical  Convention,  to  be  held  in  May,  1846. 
To  this  convention,  when  assembled,  the  following 
resolution  was  presented,  viz. — "  Resolved,  That 
the  union  of  the  business  of  teaching  and  licens- 
ing, in  the  same  hands,  is  wrong  in  principle,  and 
liable  to  great  abuse  in  practice,"  etc.  It  was 
freely  discussed,  and,  after  various  motions  to  lay 
it  on  the  table,  or  otherwise  prevent  its  being 
brought  prominently  before  the  profession  of  the 
whole  country,  it  was  sustained  by  a  majority  of 
the  members  of  the  convention,  and  referred  to  a 


MEDICAL    HISTORY.  197 

special  committee  of  seven,  wi.h  instructions  to 
report  to  the  next  convention,  to  be  held  in 
Philadelphia  the  following  year.  The  results  of 
such  reference  have  been  already  detailed  in  the 
preceding  chapter. 

From  these  historical  facts,  the  reader  will  be 
able  to  judge  of  the  propriety,  as  well  as  truth,  of 
the  following  sentence  quoted  from  an  editorial 
article  in  the  New  York  Journal  of  Medicine 
and  Collateral  Sciences,  for  July,  1847,  viz. : — 
"  With  respect  to  the  long  agitated  question  of 
uniting  the  business  of  teaching  and  licensing  in 
the  same  hands,  we  were  gratified  in  finding  the 
convention  unanimously  scouting  the  idea,  that 
such  union  '  is  wrong  in  principle,'  although  ad- 
mitted to  be  '  liable  to  great  abuses  in  practice.' ' 
1  think  it  would  puzzle  the  most  attentive  wit- 
nesses of  the  doings  of  that  convention,  or  readers 
of  its  published  proceedings,  to  find  any  evidence 
of  such  unanimous  scouting.  It  is  true  that,  in 
one  of  the  reports  made  to  that  convention  by  the 
committee,  it  is  said,  "  If  the  resolution  means  to 
affirm  that  there  is  a  moral  wrong  involved  in 
the  union,  they  cannot  accord  with  it."  But  who 
ever  before  thought  of  confounding  a  principle  of 
action  or  legislation,  affecting  whole  classes  of 
men  or  institutions,  with  a  moral  right  or  a  moral 
wrong  ?  By  a  wrong  principle,  I  mean  one  which, 


198  '  MEDICAL    HISTORY. 

when  carried  into  practical  operation,  is  found  to 
bear  such  a  relation  to  the  nature  of  man  and  the 
institutions  of  society,  that  it  directly,  and  as  it 
were,  necessarily,  leads  to  bad  results ;  while  a 
moral  wrong  is  either  a  known  commission  of 
evil,  or  a  designed  omission  of  good. 

About  the  first,  the  most  upright  and  intelligent 
men  may  and  do  honestly  differ  in  opinion.  Thus, 
some  think  it  a  correct  principle  of -action  to  pro- 
tect certain  branches  of  industry  by  taxing  the 
products  of  foreign  labor  of  the  same  kind  ;  others 
again,  contend  that  it  is  a  wrong  principle  of 
legislation  to  tax  articles  of  commerce,  even  for 
the  support  of  government.  Hence,  when  we 
speak  of  the  correctness  or  incorrectness,  the 
soundness  or  unsoundness  of  a  principle,  we  have 
reference  strictly  to  its  adaptation  to  the  nature 
and  condition  of  the  community  or  institutions  to 
which  it  may  be  applied,  and  its  tendency,  when 
carried  into  practice,  to  improve  or  injure  such 
community  or  institutions.  If  this  is  a  correct 
definition,  then  it  is  evident  that  the  question  of 
morality,  in  the  ordinary  meaning  of  that  term, 
can  have  nothing  to  do  with  the  subject.  And, 
consequently,  to  determine  whether  the  principle 
involved  in  the  union  of  teaching  and  licensing  in 
the  same  persons  is  right  or  wrong,  it  is  only 
necessary  to  inquire  whether  the  practical  opera- 


MEDICAL    HISTORY.  199 

tion  of  such  union  tends  to  elevate  the  character 
of  the  colleges,  extend  the  usefulness  of  the  profes- 
sion, and  protect  the  interests  of  the  community, 
or  not. 

That  this  union  does  not  tend  to  elevate  the 
character  of  the  medical  colleges,  is  abundantly 
evident  from  the  history  of  every  one  of  these 
institutions,  since  the  time  of  Drs.  John  Morgan 
and  William  Shippen.  If  we  ask  any  one  college 
to  extend  the  length  of  its  course  of  instruction, 
the  ready  answer  is,  "  Our  course  is  now  as  long 
as  that  of  our  neighboring  schools,  and  if  we  re- 
quire a  longer  time  of  the  student,  he  will  abandon 
us  for  our  rivals."  If  we  ask  for  greater  strictness 
in  examinations  for  the  diploma,  we  are  told  that 
"  Our  faculty  are  already  as  strict  as  any  of  our 
neighbors,  and  if  we  exact  more  of  our  candidates, 
we  shall  only  drive  students  from  our  halls  to  other 
schools,  without  any  benefit  to  the  profession." 
If  we  ask  for  an  increased  number  of  professors, 
and  a  more  perfect  division  of  labor  in  reference 
to  teaching,  the  answer  is  the  .same.  If  we  go 
from  any  single  school  to  all  the  colleges  in  any 
one  state,  and  ask  them  to  act  in  concert  with 
each  other  in  the  adoption  of  any  improvement, 
or  system  of  improvements,  we  are  solemnly 
assured  that  the  system  of  teaching  and  the  stan- 
dard of  education  in  the  institutions  of  that  state. 


200  MEDICAL    HISTORY. 

are  quite  as  elevated  as  in  any  of  the  surrounding 
states ;  and  if  they  are  raised  still  higher,  it  will 
only  cause  students  to  resort  to  the  colleges  of 
other  states  over  which  "we"  have  no  control. 

Finally,  if  we  call  together,  in  one  grand  na- 
tional council,  the  united  wisdom   of  the   whole 
profession,  from  Maine  to  Texas,  and  unanimously 
ask  all  the  colleges  to  add  two  months  to  their 
regular  courses  of  instruction,  and  add  one  or  two 
professors  to  the  number  of  their  respective  facul- 
ties, we  are  most  gravely  told  by  each  college, 
that  it  is  ready  to  comply  with  the  recommenda- 
tion so  soon  as  all  the  other  colleges  shall  do  the 
same;  and,  at  ihe  end  of  three  years,  with  very 
few  exceptions,  each  is  still  waiting  for  all  the 
others.     Thus  it  is,  that  this  union  of  teaching 
with   the   power   to   grant  diplomas,  which   are 
licenses  to  practice,  is  now,  and  ever  has  been, 
like  the  flaming  sword  at  the  entrance  of  the 
Garden  of  Eden,  turning  every  way  to  keep  out 
of  the  colleges  the  wicked  monster,  reform  or  im- 
provement.    Or,  still  move  like  the  angel  in  front 
of  the  poor  prophet,  Balaam,  and  his  ass;  if  the 
beast  went  to  the  right,  the  angel  with  his  drawn 
sword  was  there  ;  if  to  the  left,  he  was  there  also ; 
while  the  walls,  like  the  competition  between  the 
colleges,  towered  up  on  either  side  ready  to  crush 
the  foot  of  whoever   should    fall   against   them. 


MEDICAL    HISTORY.  201 

The  principal  discordance  in  the  comparison  con- 
sists in  the  fact,  that  the  faculties  connected  with 
the  several  colleges  are  not,  like  Balaaiji,  blind, 
but  they  see  plainly  their  position,  and  hence,  are 
very  content  to  let  their  beasts  remain  in  statu 
quo,  without  applying  either  whip,  or  spur.  But 
this  is  not  all ;  for  the  practice  of  looking  to  the 
colleges  for  diplomas  of  admission  into  the  profes- 
sion, changes  the  very  issue  or  question  on  which 
they  should  depend  for  their  patronage,  and  tends 
very  strongly  to  corrupt  the  minds  of  the  students. 
The  question,  and  the  only  legitimate  question, 
which  ought  to  present  itself  to  the  mind  of  the 
student,  in  determining  his  choice  of  colleges, 
should  be, — where  can  he  obtain  the  greatest 
amount  of  sound  medical  knowledge,  by  the  ex- 
penditure of  a  given  amount  of  time  and  money  ? 
If  this  was  the  case,  every  college  would  have  to 
depend  for  success  on  the  intrinsic  merits  of  its 
faculty,  and  its  means  for  illustrating  and  com- 
municating professional  knowledge.  And  hence 
the  competition  between  rival  schools  would  con- 
sist in  a  struggle  to  outdo  each  other  in  the  num- 
ber and  ability  of  their  faculties,  the  length  of 
their  courses  compared  with  their  charges,  in  the 
perfection  of  their  system  of  teaching,  and  in 
everything  which  could  aid  the  student  in  prepar- 
ing himself  for  the  arduous  duties  of  his  profes- 
9* 


202  MEDICAL    IIISTOKY. 

sion,  instead  of  striving  to  court  the  favor  ol 
students,  by  adding  to  their  facilities  for  obtaining 
a  diploma,  which  is  now  too  much  the  case. 
Hence,  the  separation  of  the  business  of  teach- 
ing from  that  of  licensing,  so  far  from  injuring, 
would  directly  benefit  the  colleges,  by  destroying 
the  advantage  which  such  power  now  gives  to  the 
poorer  schools,  and  compelling  each  to  stand 
more  exclusively  on  its  real  merits.  If  the  fore- 
going observations  are  correct,  it  certainly  follows, 
that  boards  of  examiners,  to  be  wholly  disinte- 
rested, should  be  altogether  unconnected,  as  teach- 
ers, with  the  candidates  to  be  examined. 

2d.  The  mode  of  examination  should  be  such 
as  to  constitute  a  real  test  of  the  candidate's  qua- 
lifications, independent  of  the  time  or  place  of  his 
study. 

To  accomplish  this,  the  candidate  should  not 
only  be  required  to  write  a  thesis  on  some  medi- 
cal subject,  and  submit  to  one  short  oral  examina- 
tion, but  he  should  be  required  to  report  in  writ- 
ing one  or  more  cases  of  disease,  minutely  detail- 
ing the  symptoms,  pathology,  prognosis,  and  treat- 
ment ;  and  also  examine  and  prescribe  for  one  or 
more  patients  in  the  presence  of  the  board,  giving 
not  only  the  diagnosis  and  treatment,  but  the  rea- 
sons for  both.  Such  an  examination,  fairly  car- 
ried out,  would  form  something  like  a  real  test  of 


MEDICAL    HISTORY.  203 

the  intellect  and  judgment,  as  well  as  mere  me- 
mory of  the  student ;  and,  taken  in  connection 
with  the  proper  evidences  of  good  moral  charac- 
ter, would  enable  a  board  of  .examiners  to  judge, 
with  some  degree  of  certainty,  whether  he  was 
prepared  to  maintain  the  honor  of  the  profession, 
and  do  justice  to  the  community,  or  not. 

If  the  foregoing  views,  in  regard  to  the  qualifi- 
cations which  ought  to  be  possessed  by  a  board 
of  censors  or  examiners,  and  the  kind  of  examina- 
tion which  should  be  exacted,  are  admitted,  the 
question  arises — how,  and  by  whom,  shall  such 
board  or  boards  be  appointed  ?  That  they  ought 
to  emanate  from,  and  be  responsible  to,  the  great 
mass  of  the  profession,  very  few  reflecting  men  will 
either  doubt  or  deny ;  for  certainly  the  profession 
alone  have  the  right  to  deterjnine  who  ought  to 
be  admitted  into  its  ranks,  and  who  shall,  or  shall 
not,  be  recognized  as  brethren  and  co-workers  in 
the  great  and  responsible  work  of  alleviating  and 
preventing  human  suffering.  And  to  pretend  that 
this  high  duty  ought  to  be  left  with  thirty  or  forty 
irresponsible  and  independent  chartered  institu- 
tions, acting  under  the  strong  influences  of  mu- 
tual rivalry  and  self-interest,  is  an  absurdity  with- 
out a  parallel,  in  all  the  relations  of  human 
society. 
;  But,  without  extending  these  comments  further, 


204  MEDICAL    HISTORY. 

I  shall  close  this  work  with  a  brief  statement  of 
my  views  concerning  the  particular  measures  cal- 
culated to  meet  the  wants,  and  remedy  the  de- 
fects, which  have  been  pointed  out,  and  which,  I 
believe,  to  constitute  the  only  practicable  mode  oi' 
elevating  the  profession  to  that  position  of  honor, 
usefulness,  and  learning,  which  it  ought  to  occupy 
in  every  enlightened  community. 

The  experience  of  all  countries  has  shown  that 
comparatively  little  reliance  can  be  placed  on 
legislative  action  for  promoting  the  welfare  of  the 
profession,  or  protecting  the  health  of  the  people. 
And  especially  is  this  the  case  in  our  country, 
where,  instead  of  one  central  controlling  power, 
we  must  depend  on  thirty  independent  legislative 
bodies,  and  even  these  annually  undergoing 
changes  in  accordance  with  the  popular  will.  If 
this  is  true,  then  it  follows  that  whatever  is  done 
for  the  accomplishment  of  the  above  objects,  must 
be  done  by  the  profession  itself.  Its  social  posi- 
tion, its  usefulness,  and  its  honor,  is  entirely  in  its 
own  keeping,  and  dependent  on  its  own  action. 
Indeed,  the  same  may  be  said  of  every  profession 
<r  calling  in  which  men  engage.'  For  with  us, 
public  sentiment  is  the  supreme  controlling  agent 
throughout  every  department  of  our  social  and 
political  organization.  Legislators  and  laws  are 
alike  its  creatures,  ever  ready  to  render  prompt 


MUU1CA1,    IllSTOfiY.  205 

obsdience  to  its  will.  And  what  is  true  of  the 
whole  mass  of  the  people,  is  equally  so  of  each 
individual  class  or  profession ;  and  all  that  is  ne- 
cessary, in  order  to  render  such  agent  operative 
and  efficient,  is  such  an  internal  organization  of 
each  profession  as  will  give  its  real  public  senti- 
ment embodiment  and  expression.  Hence  it  is, 
that  associated  action  has  come  to  be  the  great 
characteristic  feature  of  the  present  day. 

Every  political  campaign  is  but  a  grand  and 
systematic  organization,  to  embody  and  give  ex- 
pression to  the  public  sentiment  at  the  ballot 
boxes.  Our  courts  of  justice  serve  as  an  efficient 
organization  for  the  profession  of  law,  and  our 
numerous  ecclesiastical  assemblies,  conferences, 
and  councils,  serve  the  same  purpose  still  more 
perfectly  for  the  clerical  profession.  And  if  the 
medical  profession  ever  clears  its  ranks  from  the 
thousand  forms  of  quackery,  and  assumes  that 
position  to  which  its  nature  and  intrinsic  worth 
entitles  it,  the  same  means  must  be  promptly  and 
efficiently  applied.  Without  this,  a  statute  book, 
full  of  laws,  would  be  of  no  avail,  and  with  it  such 
laws  would  be,  to  a  very  great  extent,  unneces- 
sary. Hence,  as  the  basis  of  all  permanent  im- 
provement, I  must  place  an  efficient  internal  or- 
ganization of  the  profession.  Let  the  medical 
men  ot  each  state  form  themselves  into  district, 


206  MEDICAL    HISTORY. 

or  county  and  state  medical  societies,  and  let 
these  again  be  united  by  one  national  association, 
in  such  a  manner  that  the  sentiments  entertained 
in  the  remotest  county  may  be  heard  and  felt  at 
the  great  national  center,  and  vice  versa.  Thess 
associations  should  be  on  such  a  plan  as  to  in- 
clude in  their  basis  every  regular  and  honorable 
member  of  the  profession.  This  basis  must  be 
the  district  or  county  societies,  while  the  state 
constitutes  the  individual,  and  the  national  asso- 
ciation, the  general  head.  Hence,  both  these 
latter  should  be  so  truly  representative  in  their 
character,  as  to  give  embodiment  and  expression 
to  the  general  will. 

It  will  be  seen,  in  the  preceding  chapter,  that 
this  work  of  organization  is  not  only  begun,  but 
is  even  now  far  advanced  towards  completion. 
The  national  association  has  been  formed,  and  is 
actively  engaged  in  the  accomplishment  of  its 
legitimate  objects  ;  and  state  and  county  societies 
also  exist  in  a  majority  of  the  states;  but  these 
latter  need  re-animating,  extending,  and  multiply- 
ing, until  they  occupy  every  state,  and  include 
every  worthy  member  of  the  profession.  I  have 
so  fully  illustrated  the  ordinary  benefits  conferred 
by  such  associations  in  the  preceding  pages  of  this 
work,  that  it  is  unnecessary  to  repeat  them  in  this 
place.  But,  besides  all  these,  they  afford  the  only 


MEDICAL    HISTORY.  207 

means  for  obtaining  concert  of  action  throughout 
the  whole  profession,  and,  without  which,  no  im- 
portant improvement  in  medical  education  can 
ever  be  fully  realized.  But  with  such  an  organi- 
zation, both  local  and  general,  as  will  bring  medi- 
cal men  in  frequent  contact  with  each  other  in  a 
social  capacity,  and  bring  all  parties  to  act  in 
concert,  any  important  measure  that  may  be  de- 
sired can  be  carried,  even  to  the  enactment  of 
uniform  laws  by  the  legislatures  of  the  several 
states.  Hence,  a  thorough  organization  of  the 
profession  should  be  the  first  object  of  every  ad- 
vocate for  medical  improvement ;  and  this  orga- 
nization should  include — first,  a  board  of  censors, 
appointed  by  each  local  society,  to  examine  all 
candidates  for  admission  as  students,  in  regard  to 
their  preliminary  education ;  and  no  member  of 
such  societies  should  admit  a  student  into  his 
office  without  a  certificate  from  said  board,  cer- 
tifying that  he  is  well  versed  in  all  the  branches 
usually  taught  in  our  academical  institutions,  and 
possesses  a  good  moral  character.  And  second, 
one  board  in  each  state  for  the  examination  of  all 
candidates  for  full  admission  into  the  ranks  of  the 
profession. 

This  board  should  consist  of,  at  least,  seven 
members,  appointed  by  the  state  medical  society 
of  each  state ;  and,  if  advisable,  also,  one  addi- 


208  MEDICAL,    HISTORY. 

tional  member,  appointed,  by  each  regularly  in- 
corporated medical  college ;  and  the  presence  of 
two-thirds  should  constitute  a  quorum  for  the 
transaction  of  business.  The  board  should  meet 
at  such  time  and  place  as  the  state  society  should 
direct,  and  should  ^not  only  require  of  each  can- 
didate the  ordinary  oral  examination  in  the  va- 
rious branches  of  medical  science,  but  also,  the 
presentation  of  a  written  thesis  on  some  medical 
subject,  the  detailed  report  of  one  or  more  cases, 
and  the  examination  of  at  least  one  patient,  in  the 
presence  of  the  board.  The  examination,  and  all 
the  requirements,  should  be  the  same,  whether 
the  candidate  possesses  a  diploma  conferred  by  a 
medical  college,  or  not.  All  who  are  found  qua- 
lified should  receive  from  the  board  diplomas, 
certifying  to  such  qualifications,  and  entitling 
them  to  be  recognized  as  members  of  the  pro- 
fession throughout  the  whole  country ;  but  with- 
out such  diploma,  no  one  should  become  eligible 
to  membership  in  any  society,  or  be  countenanced 
or  consulted  with  as  practitioners.  All  fees  de- 
rived from  the  granting  of  diplomas  should  be 
paid  directly  into  the  treasury  of  the  'state  so- 
ciety by  which  the  examining  board  was  ap- 
pointed ;  and  the  members  of  such  board  should 
be  paid  a  reasonable  compensation  for  the  time 
actually  spent  in  the  performance  of  their  duties, 


MEDICAL    HISTORY.  209 

as  examiners,  by  the  same  society, — their  bills, 
duly  cei'tinad  to,  being  presented  to  a  regular 
meeting  of  the  society,  and  audited  in  the  same  man- 
ner as  provided  for  all  other  bills  of  expenditure. 

The  advantages  of  such  a  plan,  when  carried 
into  practical  operation,  are  manifold  : 

1st,  It  would  secure  the  practical  adoption  of  a 
fair  standard  of  preliminary  education,  which  is 
as  essential  to  the  elevation  and  usefulness  of  the 
profession  as  is  a  knowledge  of  geography  to  the 
naturalist. 

2d,  It  would  insure  a  more  uniform,  elevated, 
and  practical  standard  of  requirements  for  ad- 
mission into  the  ranks  of  the  profession  ;  because 
the  several  state  societies  being  directly  con- 
nected with  each  other,  through  the  medium  of 
the  National  Association,  would  almost  neces- 
sarily give  to  their  several  boards  of  censors 
similar  rules  and  exactions. 

3d,  It  would  place  the  responsibility  of  fixing 
the  qualifications,  and  regulating  the  admission  of 
members  into  the  profession,  where  it  rightfully 
and  properly  belongs,  viz.,  with  the  mass  of  the 
profession  itself. 

4th,  It  would  tend  greatly  to  elevate  the  cha- 
racter of  medical  teaching,  both  public  and  pri- 
vate, by  making  every  teacher,  and  every  faculty 
of  teachers,  depend  entirely  on  their  merits  for 


210  MEiHCAL  IllSTOKY. 

success.  Mere  speculating  associations,  or  sham 
corporations,  would  no  longer  be  able  to  draw  re- 
spectable classes  of  students  by  the  cheapness  of 
their  diplomas,  the  liberality  with  which  they  are 
distributed,  or  the  shortness  of  time  required  for 
college  attendance ;  but  the  student,  knowing 
that  the  success  of  his  final  examination  must  de- 
pend entirely  on  the  amount  and  readiness  of  his 
medical  knowledge,  his  mental  discipline,  and  his 
moral  character, — uninfluenced  by  the  fact  that 
he  has  spent  more  or  less  time  and  money  in 
this  or  that  college,  or  the  question,  whether  his 
approval  or  rejection  will  benefit  or  injure  this  or 
that  institution, — he  will  be  governed,  in  his  choice 
of  teachers  and  colleges,  by  one  simple  question, 
viz. — Where  can  I  gain  the  greatest  amount  of 
sound  medical  knowledge  for  a  given  amount  of 
time  and  money  ?  With  this  question  as  the  sole 
issue  between  the  teacher  or  the  college  and  the 
pupil,  we  should  speedily  have  a  radical  change 
in  the  nature  of  the  competition  among  our  medi- 
cal institutions.  Instead  of  a  struggle  to  outdo 
each  other  in  placing  the  diploma  in  such  a  posi- 
tion, or  on  such  terms,  as  to  be  most  effectual  in 
decoying  students  into  their  own  halls,  their  com- 
petition would  necessarily  consist  in  an  effort  to  ex- 
cel in  the  number  of  their  teachers,  and  the  length 
and  perfection  of  their  courses,  compared  with 


MEDICAL    H1STORV.  211 

their  charges, — a  competition  tending,  necessarily, 
to  progression  and  improvement,  instead  of  the 
reverse,  which  now  prevails.  Indeed,  nothing 
hangs  as  a  heavier  incubus  on  all  attempts  to  im- 
prove our  system  of  medical  education,  than  this 
connection  of  licensing  and  teaching.  It  enables 
the  merest  shadow  of  a  college,  with  its  thirteen 
or  fourteen  weeks'  lecture  term,  and  perhaps 
two  of  these  in  one  year,  to  issue  diplomas  just 
as  large,  couched  in  just  as  flourishing  Latin,  con- 
ferring just  as  many  privileges,  and,  as  the  stu- 
dent well  knows,  having  just  as  much  influence 
with  the  great  mass  of  the  community  as  the 
best,  most  thoroughly  organized,  and  most  rigid 
institution  in  the  Union,  —  hence,  one  of  the 
strongest  motives  to  real  excellence  in  teaching 
is  done  away  with,  and  the  poorest  college  is 
given  a  decided  advantage  over  the  best. 

It  is  on  this  ground  that  I  have,  for  several 
years,  urged  this  separation,  as  a  measure  of  real 
benefit  to  the  colleges  themselves,  and  as  the  only 
one  which  would  ever  enable  tho  good  institu- 
tions to  reap  the  full  benefit  of  their  merits,  in 
opposition  to  the  badly  managed  and  worthless. 
Indeed,  the  whole  history  of  mankind,  in  all 
ages  and  countries,  has  not  more  clearly  demon- 
strated the  truth  of  any  proposition  than  this — 
that  every  class  of  institutions,  whether  educa- 


212  MEDICAL    HISTORY. 

tional  or  industrial,  not  only  flourish  best,  but  are 
most  progressive  and  improving  in  their  condi- 
tion, \vhen  left  to  depend  entirely  on  their  own 
merits  for  patronage  and  success. 

5th,  It  would  insure  both  permanence  and 
efficiency  in  the  social  organization.  Those  who 
study  carefully  the  history  of  those  medical  so- 
cieties and  associations  which  have  been  formed, 
from  time  to  time,  in  different  states,  will  not  fail 
to  perceive  that,  with  very  few  exceptions,  they 
have  flourished  for  a  few  years  only,  and  then 
maintained  a  nominal,  rather  than  an  active,  state 
of  existence.  Thus,  from  1810  to  1830,  an  active 
spirit  of  medical  organization  prevailed,  resulting 
in  the  formation  of  state  and  county  or  district 
societies,  in  a  large  majority  of  the  states  then 
existing  in  the  Union.  At  first,  many  of  these 
had  boards  of  censors,  whose  fees,  derived  from 
the  examination  and  licensing  of  students,  not 
only  defrayed  their  ordinary  expenses,  but,  with 
a  trifling  initiatory  tax,  served  to  accumulate 
valuable  society  libraries,  and  the  interest  felt  in 
their  regular  meetings  continued  unabated.  But, 
as  already  shown  in  the  historical  part  of  our 
work,  the  college  diploma  rapidly  superseded  the 
state  and  county  licenses  in  all  the  states  except, 
perhaps,  Delaware  and  Louisiana,  where  a  state 
license  is  still  required  by  law. 


MEDICAL    HISTORY.  213 

The  societies  being  thus  left  to  depend  entirely 
on  the  voluntary  contributions  of  the  practitioner, 
who  must  tax  himself  to  support  the  county 
society,  spend  his  time,  and  tax  himself  again  to 
pay  traveling  expenses,  and  to  sustain  the  state 
organization,  soon  began  to  loose  their  interest, 
and  fall  into  a  state  of  inactivity.  So  true  was 
this,  that,  though  state  and  district  medical  socie- 
ties had  previously  been  formed  in  all  the  eastern 
states — in  New  York,  New  Jersey,  Delaware, 
Maryland,  Mississippi,  Alabama,  Tennessee,  Ohio, 
Indiana,  and  Michigan — yet,  in  1840,  those  in'' 
Massachusetts  and  New  York  were  almost  the 
only  ones  that  maintained  anything  more  than  a 
mere  nominal  existence.  And  even  in  the  latter 
state,  out  of  its  sixty  counties,  not  more  than  six- 
teen or  seventeen  were  represented  in  the  meet- 
ings of  the  state  society.  Since  the  successful 
organization  of  the  American  Medical  Associa- 
tion, and  the  general  interest  which  has  been 
excited  on  the  subject  of  medical  education,  a 
new  and  active  spirit  of  social  organization  has 
been  rekindled.  Hence,  during  the  last  four  years, 
most  of  the  old  societies  have  teen  re-animated, 
and  new  ones  have  been  formed  in  most  of  the 
states,  where  none  existed  before,  such  as  Penn- 
sylvania, South  Carolina,  Georgia,  Illinois,  Iowa, 
and  Wisconsin.  As  proof  of  the  present  activity 


214  MEDICAL    HISTORY. 

of  this  spirit,  it  is  only  necessary  to  mention,  that 
over  four  hundred  delegates  were  in  attendance 
on  each  of  the  last  two  meetings  of  the  American 
Medical  Association,  the  one  in  Boston,  the  other 
in  Cincinnatti,  and  that  many  of  these  traveled 
more  than  a  thousand  miles,  at  their  own  expense, 
for  that  purpose.  But  does  any  one  suppose  that 
this  spirit  will  contiuue  year  after  year,  under  the 
influence  of  such  personal  sacrifices  of  time  and 
money  ?  It  requires  only  an  ordinary  knowledge 
of  human  nature,  and  of  the  past  history  of  medi- 
cal associations,  to  see  clearly  that,  without  some 
collateral  aid,  some  permanent  resource  for  light- 
ening the  burthens  and  increasing  the  interest  of 
such  organizations,  they  will  inevitably  sink  into 
a  mere  nominal  existence,  so  soon  as  the  exciting 
subjects  which  brought  them  into  being  cease  to 
be  the  predominant  topics  of  interest.  But  if 
each  state  organization  could  receive  an  annual 
income  sufficient  to  defray  its  ordinary  expenses, 
publish  its  transactions,  and,  perhaps,  enable  it  to 
offer  a  premium  for  original  essays,  or  defray  the 
expense  of  original  experimental  investigations, 
it  would  not  only  insure  the  permanent  prosperity 
of  such  organization,  but  it  would  prove  one  of 
the  most  powerful  means  of  improving  the  whole 
literature  and  science  of  the  profession. 

One  of  the  primary  objects  I  had  in  view  when 


MEDICAL    HISTORY.  215 

I  presented  the  first  series  of  resolutions  in  the  New 
York  State  Medical  Society,  in  1844,  advocating 
the  separation  of  the  licensing  from  the  teaching 
power  in  our  colleges,  and  investing  it  in  state 
censors,  was  to  put  into  the  possession  of  the  state 
societies  such  an  income,  for  precisely  such  a 
purpose.  That  this  was  a  leading  object,  will  be 
seen  by  a  reference  to  the  resolutions  themselves, 
as  published  in  the  transactions  of  that  society. 

It  will  be  seen  by  reference  to  the  report  of  the 
committee  on  medical  education,  contained  in  the 
Transactions  of  the  American  Medical  Associa- 
tion lor  1849,  that  nearly  fourteen  hundred  were 
admitted  into  the  profession  during  the  year  pre- 
vious, by  receiving  diplomas  from  the  several  me- 
dical colleges  in  our  country.  These,  at  twenty 
dollars  each,  gave  those  colleges  no  less  than 
twenty-eight  thousand  dollars.  Now,  suppose  this 
sum  was  annually  received  by  boards  of  examiners, 
one  for  each  state,  and  turned  directly  into  the 
treasury  of  the  state  societies,  every  reader  will 
see  that  it  would  afford  an  ample  fund  for  paying 
the  examining  boards,  publishing  the  annual 
transactions  of  the  several  societies,  and  enable 
each  to  powerfully  encourage  original  investiga- 
tions by  premiums  or  experimental  committees ; 
and  who  can  calculate  the  beneficial  results  that 
would  accrue  to  the  whole  profession  by  thus  ren- 


216  MEDICAL    HISTORY. 

dering  its  organizations  permanent  and  prosper- 
ous, and  maintaining  an  active  and  ever-increas- 
ing spirit  of  scientific  inquiry  ?  It  may  be  said 
that  the  loss  of  this  fund  would,  by  crippling  the 
colleges,  injure  the  cause  of  medical  education  as 
much  as  it  would  advance  it,  in  the  manner  pro- 
posed ;  but  if  we  remember  that  there  are  about 
four  thousand  five  hundred  students  annually  in 
attendance  on  the  several  colleges,  and  that  a 
matriculation  fee  of  five  dollars  for  each,  after  de- 
ducting five  hundred  as  third  course  students 
would  give  no  less  than  twenty  thousand  dollars, 
besides  the  entire  receipts  for  lecture  fees,  we 
shall  be  satisfied  that  these  institutions  would 
have  no  cause  to  complain.  And  even  if  such  a 
course  should  cause  a  school,  here  and  there,  to 
close  its  doors,  it  is  by  no  means  certain  that 
either  the  profession  or  the  community  would 
suffer  thereby. 

This  leads  us  to  a  consideration  of  the  last  sub- 
ject mentioned,  when  speaking  of  the  wants  of 
the  profession,  viz.,  the  adoption  of  such  a  college 
organization,  and  such  a  rate  of  lecture  fees,  as 
will  induce  a  far  larger  proportion  of  those  who 
practice  medicine  to  qualify  themselves  thoroughly, 
before  entering  upon  the  discharge  of  duties  so 
arduous  and  responsible.  Nothing  need  be  added 
to  what  has  already  been  said  in  regard  to  the 


MEDICAL    HISTORY.  217 

insufficient  length  of  our  present  college  terms. 
That  a  sixteen  weeks'  term,  with  six  lectures  per 
day,  on  as  many  different  and  important  topics, 
not  only  induces  the  majority  of  students  to  pass 
over  the  whole  hastily,  or  neglect  a  part  for  the 
sake  of  mastering  the  rest  more  thoroughly,  but 
also  effectually  prevents  th3  great  mass  of  stu- 
dents from  paying  that  attention  to  practical  ana- 
tomy, chemistry,  and  clinical  practice  in  hospitals, 
etc.,  even  where  these  latter  are  abundantly  ac- 
cessible, no  man  can  consistently  deny. 

Let  the  reader  inquire  how  many  of  the  thou- 
sand students  who  annually  congregate  in  Phila- 
delphia, or  of  the  seven  hundred  who  spend  their 
winter  in  New  York,  are  daily  found  studying 
with  care  the  most  important  of  all  subjects,  viz. 
— clinical  medicine  and  surgery,  at  the  bed-side, 
in  the  capacious  hospitals  of  those  cities  ?  I  speak 
from  personal  observation,  when  I  say  that  not 
one  in  twenty  are  found  paying  attention  to  these 
things.  And  why  ?  Simply  because  they  have 
no  time.  They  must  be  in  the  lecture  rooms  of 
the  college  from  nine  or  half-past  nine  in  the 
morning  to  half-past  twelve,  and  from  three  to 
six  in  the  evening  ;  during  which  time  they  must 
listen  to  chemistry,  anatomy,  physiology,  mid- 
wifery, surgery,  and  practice  of  medicine :  and 

if,  during  the  interval,  we  allow  to  them  the  same 
10 


218  MEDICAL    HISTORY. 

necessities  for  eating  and  sleeping  that  we  do  to 
other  human  beings,  where  is  their  time  for  the 
minute  study  of  anatomy,  healthy  and  morbid,  for 
acquiring  practical  tact  in  physical  diagnosis,  and 
for  patient  observation  of  disease  at  the  bed-side  ? 
The  bare  statement  of  the  case  shows  its  palp- 
able absurdity. 

If  we  would  ever  raise  the  medical  profession 
to  that  condition,  in  regard  to  learning  and  prac- 
tical skill,  which  justice  to  itself  and  the  com- 
munity imperiously  require,  two  things  must  be 
done: 

1st,  All  those  medical  colleges  that  are  so  lo- 
cated as  to  afford  their  students  the  necessary 
facilities  for  the  study  of  anatomy,  healthy  and 
morbid,  and  the  free  access  to  well-regulated 
hospitals,  must  not  only  double  the  length  of 
time  during  which  their  lectures  continue,  but 
such  time  must  be  suitably  divided  into  minor 
terms.  Thus,  if  the  colleges  in  all-  our  large 
cities  would  continue  their  courses  of  instruction 
through  nine  or  ten  months  of  the  year,  dividing 
such  tim3  into  three  sections,  and  assigning  four 
distinct  branches  to  each  section,  thereby  occu- 
pying four  hours  each  day  in  the  lecture  room, 
instead  of  six,  and  requiring  the  student  to  spend 
the  remaining  two  hours  in  clinical  study  at  the 
hospital,  including  dead-house  observations  in 


MEDICAL    HISTORY.  219 

morbid  anatomy,  and  personal  practice  in  phy- 
sical diagnosis,  they  .would  not  only  present  the 
requisite  facilities  for  obtaining  the  right  kind  of 
medical  knowledge,  but  would  also  give  the  stu- 
dent a  chance  to  avail  himself  of  those  facilities. 
The  different  branches  should  be  so  grouped  in 
the  three  sections,  that  all  students  studying  three 
years  would  find  it  profitable  to  take  tickets,  and 
attend  on  one  section  only  each  year  of  his  study. 

With  such  a  college  arrangement,  the  student 
would  be  enabled  to  take  up  four  branches  each 
successive  year  of  his  study,  and  by  confining  his 
attention  to  these,  both  during  his  attendance  on 
the  college  and  in  the  interval,  instead  of  skim- 
ming each  year  over  the  whole  field  of  medical 
sciences,  he  would  make  himself  thoroughly  ac- 
quainted with  each,  in  its  turn,  and,  at  the  same 
time,  acquire  a  mental  discipline,  far  superior  to 
that  obtained  under  the  present  arrangement. 

At  present,  first  course  students,  many  of  whom 
have  scarcely  studied  long  enough  to  learn  the 
number  of  bones  in  the  human  skeleton,  are  com- 
pelled to  pay  for  tickets  and  listen  to  lectures  on 
practical  medicine,  surgery,  and^nidwifery,  before 
they  have  the  slightest  knowledge,  either  of  the 
organs  diseased,  the  remedies  recommended,  or 
the  anatomical  structures  operated  on.  In  a 
word,  they  are  set  to  laying  the  foundation, 


220  MEDICAL    HISTORY. 

building  the  superstructure,  and  putting  in  the 
furniture,  all  at  the  same  time — a  task  as  difficult 
as  it  is  absurd.  But  let  the  whole  annual  session 
be  lengthened  and  divided,  in  the  manner  pro- 
posed, and  students,  in  the  first  year  of  study,  can 
take  the  tickets  for  that  section  adapted  to  their 
period  of  progress,  and  concentrate  all  their  at- 
tention on  a  thorough  mastery  of  anatomy,  and 
the  other  more  elementary  branches  ;  those  in  the 
second  year  would  take  the  tickets  of  another 
section,  adapted  to  their  stage  of  progress,  and 
spend  their  time  between  the  lectures  in  paying 
special  attention  to  morbid  anatomy  and  path- 
ology, illustrated  by  post-mortem  examinations; 
while  those  in  the  third  or  last  year,  having  thus 
aid  a  systematic  foundation,  would  take  the 
section  embracing  instruction  in  the  more  purely 
practical  branches,  and  be  able  to  devote  all  their 
time  out  of  the  lecture  room  to  genuine  clinical 
medicine  and  surgery  at  the  bed-side.  Such  an 
arrangement  would  require  the  student  to  attend 
the  college  no  longer  in  any  one  year  than  he 
does  now,  would  compel  him  to  attend  no  more 
branches  at  one  time  than  he  could  profit  by  to 
the  greatest  advantage,  and  yet  would  give  him 
ten  months  of  college  instruction  during  his 
period  of  study,  instead  of  eight,  which  is  now 
required. 


MEDICAL    HISTORY.  221 

It  is  not  only  necessary  thus  to  extend  and  di- 
vide the  college  terms,  but  the  rate  of  charges 
for  lecture  fees  must  be  more  nearly  adapted  to 
the  actual  pecuniary  condition  of  the  great  mass 
.af  medical  students.  The  facts,  that  a  propor- 
tion, varying  from  one-fourth  lo  one-half,  of  ail 
the  practitioners,  in  many  of  the  states,  have 
never  attended  a  course  of  lectures  in  any  school, 
— that  a  considerable  proportion  of  those  who  do 
attend  are  obliged  to  give  notes,  and  obtain  their 
lectures  on  credit, — and  that  almost  one-half  of 
of  the  whole  number  of  those  who  graduate,  do 
so  at  schools,  so  located  that  they  can  have  no 
hospital  or  genuine  bed-side  instruction  whatever, 
and  but  a  limited  access  to  the  study  of  practical 
and  morbid  anatomy, — are  abundantly  sufficient 
to  prove  that  the  present  custom  of  charging  from 
ten  to  fifteen  dollars  per  ticket  for  lecture  fees,  or 
from  sixty  to  one  hundred  and  five  dollars  for  each 
course  of  four  months,  is  a  very  great  barrier  in 
the  way  of  a  more  thorough  education  of  the 
medical  profession.  It  is  utterly  useless  for  the 
American  Medical  Association  to  reiterate,  from 
year  to  year,  its  recommendation,  that  medical 
students  be  required  to  pursue  practical  anatomy, 
by  dissections,  and  to  attend  to  clinical  instruc- 
tion in  hospitals  a  given  length  of  time,  so  long  as 

the    amount  of  lecture  fees   required  by  those 
10* 


222  ^MEDICAL,    HISTORY. 

colleges,  so  located  as  to  afford  the  required  faci- 
lities, is  such  as  to  wholly  preclude  a  large  ma- 
jority of  the  whole  number  of  students  from 
attending  them.  The  object  which  it  is  desirable 
to  accomplish  is  plain  and  obvious,  viz. — to  induce 
a  far  larger  proportion  of  those  (I  should  rather 
say,  to  induce  all  those)  who  intend  to  practice 
medicine,  to  prepare  themselves  more  thoroughly 
and  more  practically,  before  commencing  their 
arduous  duties.  And  how  can  this  be  done? 
Most  obviously  by  placing  the  required  facilities 
for  such  preparation  more  fully  within  their 
reach. 

This  position  was  most  ably  presented  by  the 
learned  and  eminent  Dr.  Alexander  H.  Stevens, 
of  New  York,  one  of  the  ex-presidents  of  the 
American  Medical  Association,  in  his  annual  ad- 
dress before  the  New  York  State  Medical  So- 
ciety, delivered  in  the  Assembly  Chamber,  at 
Albany,  in  February,  1849;  and  to  accomplish 
this  object  to  the  fullest  extent,  he  made  a  most 
just  and  well  reasoned  appeal  to  the  State  Legis- 
lature, to  so  endow  the  medical  colleges,  that  the 
lecture  fees  might  be  entirely  abolished,  and 
medical  education  be  thereby  made  free  to  every 
deserving  student.  The  address  of  Dr.  Stevens 
was  very  extensively  read,  and  its  sentiments 
were  generally  approved  by  the  profession.  Being 


MEDICAL    HISTORY.  223 

fully  impressed  with  the  importance  of  the  object 
to  be  accomplished,  and  also,  of  the  correctness 
of  the  principle  involved  in  the  measure  proposed 
for  accomplishing  it,  (viz. — the  reduction  of  the 
lecture  fees,)  the  faculty  of  the  Rush  Medical 
College,  located  at  Chicago,  Illinois,  in  the  autumn 
of  1819,  announced  to  their  class  a  reduction  of 
their  fees  from  seventy  dollars  to  thirty-six  dollars 
for  the  whole  course.  Although  this  announce- 
ment was  first  made  in  the  regular  introductory  lec- 
ture to  the  course,  by  the  author  of  this  work,  yet 
it  induced  several  students,  who  had  not  intended 
to  attend  the  lectures  of  any  school,  on  account 
of  want  of  means,  to  immediately  come  forward 
and  avail  themselves  of  the  advantages  of  the 
whole  course ;  and  so  well  satisfied  were  the  fac- 
ulty of  that  school,  that  the  measure  would  not 
only  work  great  good  to  the  profession,  by  enabl- 
ing a  much  larger  number  of  those  who  study  and 
practice  medicine  to  educate  themselves  better, 
but  would  contribute  greatly  towards  doing  away 
with  the  necessity  for  giving  credit  to  students, 
that  in  their  annual  announcement  for  1850-51, 
they,  have  reduced  the  expense^of  a  full  course 
still  further,  by  abolishing  the  matriculation  fee, 
and  making  the  gross  amount  of  lecture  fees 
thirty-five  dollars,  payable  in  advance. 

During  the  present  year,  also,  the  Medical  De- 


' 


224  MEDICAL    HISTORY. 

partment,  of  the  University  of  Michigan,  has  been 
organized,  and  their  circular  issued  for  the  first 
regular  course  of  instruction,  to.  commence  in  the 
autumn  of  the  present  year.  This  being  a  depart- 
ment of  the  State  University,  which  is  liberally 
endowed  with  an  income  derived  from  the  sale  of 
public  lands  in  that  state,  the  professors  are  paid 
regular  salaries,  and  no  other  charge  made  on  the 
medical  student,  than  a  matriculation  fee  of  ten 
dollars.  They  have  also  adopted  a  lecture  term 
extending  through  seven  months  of  the  year. 
They  have  thus  made  provision  for  carrying  out 
to  the  full  extent,  the  important  principles  an- 
nounced by  Dr.  Stevens,  and  acted  upon  as  far 
as  pecuniary  resources  would  permit,  by  the  Rush 
Medical  College,  at  Chicago.  I  see  by  their  re- 
cent circulars  that  some  of  the  other  western  col- 
leges, have  also  diminished,  to  a  moderate  extent, 
the  gross  amount  of  their  lecture  fees ;  so  that 
this  reform  may  be  said  to  have  fairly  com- 
menced. 

But  to  accomplish  fully  the  object  in  view,  that 
is,  to  induce  all  who  study  medicine  to  educate 
themselves  better,  it  is  not  only  necessary  to  in- 
duce all  to  avail  themselves  of  college  instruction, 
but  it  is  desirable  to  induce  them  to  attend  those 
colleges,  which  not  only  provide  a  suitable  num- 
ber of  lectures,  but  also  abundant  anatomical  and 


MEDICAL    HISTORY.  225 

hospital  facilities.  This  certainly  cannot  be  done 
under  the  present  system,  whch  enables  those 
schools,  located  entirely  beyond  the  reach  of  hos- 
pital or  other  facilities  for  practical  instruction, 
to  draw  into  their  halls  one  half  of  the  whole  num- 
ber of  students,  by  the  lower  rate  of  their  charges. 
If  all  the  medical  schools  in  our  country,  whose 
location  places  always  at  their  command  ample 
facilities  for  genuine  clinical  or  practical  instruc- 
tion, would  adopt  the  system  I  have  developed  in 
these  pages,  viz. : — 

1st.  Extend  their  lecture  terms  to  ten  months, 
instead  of  four ;  divide  it  into  three  sections,  with 
the  medical  sciences  grouped  into  twelve  divi- 
sions or  chairs,  four  for  each  section  of  the  term  : 
and  requiring  four  hours  of  each  day  to  be  occu: 
pied  in  regular  lectures,  and  two  in  special  at- 
tention to  the  study  of  practical  anatomy,  healthy 
and  morbid,  and  to  clinical  medicine  and  surgery, 
with  their  appendages,  including,  of  course,  phy- 
sical diagnosis,  etc. 

2d,  Have  the  several  chairs  so  arranged  in  each 
section  of  the  term,  that  students  should  be  re- 
quired to  attend  one  section  x^nly  each  year  of 
their  studies,  the  section  for  the  last  year  embrac- 
ing the  branches  more  especially  practical,  such 
as  practical  medicine,  surgery,  midwifery,  etc. 

3d,  Instead  of  the  present  system  of  charges, 


226  MEDICAL    HISTORY. 

embrace  the  whole  expense  of  attendance  on  any 
one  section  of  the  general  term,  except  a  charge 
for  anatomical  subjects  and  dissecting  ticket,  in 
an  initiatory  or  matriculating  fee  of  twenty-five 
dollars,  payable  always  in  advance — they  would 
immediately  induce  a  much  larger  proportion  of 
students  of  medicine  to  attend  lectures — they 
would  make  their  medical  education  far  more 
thorough,  systematic,  and  practical,  thereby 
greatly  benefiting  both  the  profession  and  the 
community ;  and  they  would  rapidly  concentrate 
in  their  own  halls  the  whole  patronage  of  the 
profession,  and  thereby  benefit  themselves  and  do 
much  to  destroy  the  petty  college  competition 
which  is  now  so  rife  throughout  the  country. 
And  if  the  sum  now  annually  lost  to  the  colleges, 
by  giving  students  credit,  and  making' deductions 
in  special  cases,  should  be  added  to  that  which 
would  be  paid  by  the  additional  number  who 
would  resort  to  these  institutions,  it  would  more 
than  counterbalance  the  loss  by  a  reduction  of 
fees.  Indeed,  if  the  number  of  students  resorting 
to  the  colleges  should  remain  the  same  as  at  pre- 
sent (four  thousand  five  hundred),  the  charge  of 
twenty-five  dollars  each  would  give  one  hundred 
and  twelve  thousand,  five  hundred  dollars  annu- 
ally, a  sum  sufficient  to  pay  two  hundred  profes- 
sors an  average  annual  salary  of  five  hundred 


MEDICAL    HISTORY  227 

dollars  each,  and  leave  twelve  thousand  five  hun- 
dred dollars  to  defray  the  ordinary  college  ex- 
panses. These  sums,  taken  in  connection  with 
the  increased  division  of  labor,  in  making  twelve 
instead  of  seven  chairs  in  each  school,  and  the 
concentration  of  the  whole  or  a  much  smaller 
number  of  schools  properly  located,  would  make 
stations  in  the  colleges  abundantly  sought  after, 
and  as  well  paid  as  any  other  positions  in  the 
profession.  And  if,  in  connection  with  such  a 
system  of  teaching,  a  complete  and  permanent 
system  of  social  organization,  requiring  a  proper 
preliminary  education,  and  providing  for  an  effi- 
cient board  of  medical  examiners  in  each  state, 
as  already  pointed  out,  was  adopted,  the  medical 
profession  of  our  country,  numbering,  as  it  now 
does  in  its  ranks,  many  of  the  most  eminent  and 
learned  men  on  the  continent,  would,  as  a  whole, 
speedily  assume  a  more  elevated  position,  and 
occupy  a  much  wider  field  of  usefulness.  In 
regard  to  the  objection,  that  cheapening  medical 
education  would  only  increase  the  number  of 
those  who  would  crowd  into  the  profession,  I 
have  simply  to  remark,  that  the  numbers  should 
be  restricted  by  adding  to  the  standard  of  require- 
ments, instead  of  increasing  the  exactions  on  the 
students'  pockets — the  latter  being  both  injurious 
and  anti-republican  in  all  its  tendencies. 


228  MEDICAL    HISTORY. 


CONCLUSION. 

I  had  originally  intended  to  close  this  chapter 
with  some  observations  on  the  subject  of  medical 
legislation,  but  it  has  already  so  much  exceeded 
the  limits  to  which  I  designed  restricting  it,  that 
I  can  no  more  than  allude  to  the  general  topic. 
That  the  medical  profession,  as  such,  either  needs 
or  desires  any  legislation  for  its  own  special  pro- 
tection, I  most  emphatically  deny.  Legitimate 
medicine  has  continued  steadily  advancing  in  the 
accumulation  of  its  facts,  in  the  verification  of  its 
principles,  and  in  the  extension  of  its  usefulness, 
for  more  than  eighteen  hundred  years ;  and  who- 
ever supposes  it  needs  any  legal  protection  against 
any  or  all  the  thousand  forms  of  quackery  or 
pretended  special  systems,  or  isms,  or  athys,  is 
altogether  mistaken.  Whether  the  citizens  of  this, 
our  noble  republic,  need  any  laws  to  protect  them 
and  their  families  from  the  grossest  and  most  fatal 
impositions,  under  the  name  of  medicine  and 
medical  treatment,  is  another  and  entirely  diffe- 
rent question.  A  question,  indeed,  not  only  wor- 
thy of,  but  imperiously  demanding  the  most 
careful  consideration  of  every  legislator  and 
friend  of  humanity.  But  neither  our  limits  nor 
the  strict  design  of  this  book,  wiH  permit  its  dis- 
cussion in  this  place. 


."* 


....  *&< 


-.,  y. 


